Oradell Animal Hospital Diet History Form

Fax to: (201) 262-4275 or e-mail to: [email protected] Once received, you will be contacted to schedule an appointment.

Please send ALL physical exam forms, diagnostic test results (lab work, ultrasound/radiography reports, biopsy reports, bladder stone analysis, etc.) from EVERY veterinarian your pet has seen in the past 12 months (longer for more chronic conditions) to Oradell Animal Hospital. Once medical records and diet history form are received, you will be contacted by the nutrition technician to schedule an appointment.

Please list all food(s) you currently feed at mealtime. Include ALL commercial pet foods. If you add human food items to a commercial food, please list that as well. If you cook for your pet provide the detailed recipe (for example “4 ounces of 85% lean ground beef pan-fried & 1 cup of cooked long-grain brown rice daily”) The description should provide enough detail that the reader could purchase the same food or prepare the exact recipe.

List all treats & “between meal snacks” include biscuits, pet treats, rawhides, pig’s ears, table foods etc. Anything given as a “snack” or “treat”

Please list other foods your pet has received in the past but is NOT currently eating, indicating the approximate time period when they were fed. Examples are given in italics.

Please list the name of each additional nutritional supplement your pet receives, indicate how much and how often your pet receives it (i.e. herbal product, fatty acid, vitamin or mineral supplement):

Please list your pet’s current and past medical problems, if any, date/year diagnosed, and whether they have been resolved or not:

Please list all the medications your pet is currently receiving and any administered over the past three months (indicate medications that are current and doses/strengths and frequency):