Nutrition Consultation Form
Have questions?
(512) 601-5030
nutrition@fosteringpetnutrition.com
Please Note
I understand that a nutrition consultation with Dr. Foster is a for fee service and that I am required to pay such fees prior to any work beginning on my consultation.
Ready to
start the consultation process?
Start Pre-consultation
This form takes about
15 minutes to complete
Please have your pet's medical records and primary veternarian contact information available
Please
note...
Before a consultation with Dr. Foster, we must receive all of the following:
Pre-Consultation Form
This is the form you'll be completing now.
Veterinary Referral Form
You'll receive an e-mail after completeing this form that you will need to forward to your referring veterinarian. It includes a link they can follow to provide required information.
Pertinent Medical Records
All pertinent medical records from your referring veterinarian including a CBC, chemistry, T4 and urinalysis performed within the last 6 months.
If your pet's labwork is not up-to-date, you'll need to schedule an appointment with your primary veterinarian to update your pet's records before your consultation can proceed.
I Understand
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Please enter your
contact information
This information should match what's on file with your veterinarian
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo The Democratic Republic Of The
Cook Islands
Costa Rica
Cote D'Ivoire (Ivory Coast)
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia The
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey and Alderney
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau S.A.R.
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man (Isle of)
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Bonaire, Sint Eustatius and Saba
Netherlands The
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory Occupied
Panama
Papua new Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent And The Grenadines
Saint-Barthelemy
Saint-Martin (French part)
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis And Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Kosovo
Curaçao
Sint Maarten (Dutch part)
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Please enter contact information for your
primary care veterinarian
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo The Democratic Republic Of The
Cook Islands
Costa Rica
Cote D'Ivoire (Ivory Coast)
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia The
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey and Alderney
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau S.A.R.
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man (Isle of)
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Bonaire, Sint Eustatius and Saba
Netherlands The
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory Occupied
Panama
Papua new Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent And The Grenadines
Saint-Barthelemy
Saint-Martin (French part)
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis And Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Kosovo
Curaçao
Sint Maarten (Dutch part)
State
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What is your
pet's first name?
This should be the same name on file with your pet's primary veterinarian
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Is
your pet
a
cat or a dog?
Dr. Foster only provides consultations for canine and feline patients
Please select...
Cat
Dog
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What are your goals
when seeking a nutrition consultation for
your pet
?
You can select multiple options and will be able to enter a custom goal
Recommendations for Commercial Diet
Formulate Home-prepared Diet
Balance Existing Home-prepared Diet
Weight Loss Plan for Overweight or Obese pet
Other (Please explain below)
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What breed
is
your pet
?
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Is
your pet
male or female?
Please select...
Male
Female
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Is
your pet
spayed or neutered?
Please select...
Yes
No
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How old
is
your pet
?
This should be in actual years and months. No cat or dog years please!
years
months
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What is
your pet
's
current weight?
lb
kg
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When was
your pet
's weight
last checked?
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How would you score
your pet
's
body condition?
5 -
Ideal
1 - Emaciated
4 - Ideal - 5
Morbidly Obese - 9
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Is
your pet
experiencing
any muscle loss?
Please select...
Normal Muscle
Mild Muscle Loss
Moderate Muscle Loss
Severe Muscle Loss
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Please list any
current
medical issues or diagnoses
for
your pet
in the box below:
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Please list any
prior
medical history
for
your pet
, and whether prior conditions have been resolved
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Please list
any medications, including supplements,
your pet
is
currently
taking
Please include medication or supplement name and dosage per day
Example: Prednisone (5mg Tablets): 1 1/2 tablets twice daily
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Please add any and all pet
food, human food, treats, and snacks
your pet
is
currently eating
If feeding a homemade diet, please list each ingredient separately.
Brand
Formulation
Diet Type
Amount Per Serving
Servings Per Day
Fed Since
Add Another Food
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Done adding foods
Please
add any and all food
your pet
has
received in the past
If feeding a homemade diet, please list each ingredient separately.
Brand
Formulation
Diet Type
Amount Per Serving
Servings Per Day
Date Ended
Reason for ending this food
Add Another Food
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Done adding foods
How is
your pet
's
appetite?
Please select...
Excellent
Moderate
Sometimes Poor
Always Poor
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How would you describe
your pet
's
eating behavior?
Please select...
Eats Entire Meal at Once When Fed
Eats Entire Meal but Leaves and Comes Back to it
Eats Only Part of the Meal or Specific Parts of Meal
Other (Please explain)
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Have
your pet
's
eating habits
changed recently?
Please select...
Yes
No
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Have
your pet
's
drinking habits
changed recently?
Please select...
Yes
No
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Have
your pet
's
urination habits
changed recently?
Please select...
Yes
No
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Has
your pet
had a change to
their
bowel movements
recently?
Please select...
Yes
No
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Has
your pet
's
weight changed
recently unintentionally?
Please select...
Gained Weight
Lost Weight
No Change
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Has
your pet
been
vomiting
recently?
Please select...
Yes
No
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Is
your pet
suspected or diagnosed with suffering from
food allergies or inflammatory bowel disease?
Please select...
Yes
No
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Please list any
food, ingredient, products, or diet
your pet
is known to be
allergic, sensitive to, or does not tolerate
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Please list any
other pets
, if any, that share a home with
your pet
Please include the name, species, and breed of each pet
Example: Rover - Dog - Labrador Retriever
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Does
your pet
have access to
other pets' food?
Please select...
Yes
No
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Does
your pet
have access to
food in or around the kitchen
in your home?
Please select...
Yes
No
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Does
your pet
spend more time
indoors or outdoors?
Please select...
Indoors
Outdoors
Both Equally
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How would you describe
your pet
's
level of activity?
Please select...
Very Active
Moderately Active
Occasionally Active
Sedentary
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Please list any
activities
your pet
does daily
Please include how often and for how long
Example: Walk - Twice Daily - 30 Minutes
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Are you interested in a
home-prepared diet
for
your pet
?
Please select...
Yes
No
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Please select at least 1 or more
protein sources
Please select foods that are available to you and enjoyed or tolerated by
your pet
Chicken Breast
Chicken, other
Ground Beef
Beef, other
Venison
Lamb
Turkey
Pork
Soybean/Tofu
Egg
Cottage Cheese
Yogurt
Pinto Beans
Garbanzo Beans
Tilapia
Tuna
Salmon
Other Fish
Shrimp
Seafood, other
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Please list any other
sources of protein
you'd like to include
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Please select any foods
your pet
has
never eaten
Chicken Breast
Chicken, other
Ground Beef
Beef, other
Venison
Lamb
Turkey
Pork
Soybean/Tofu
Egg
Cottage Cheese
Yogurt
Pinto Beans
Garbanzo Beans
Tilapia
Tuna
Salmon
Other Fish
Shrimp
Seafood, other
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Continue
Please select at least 1 or more
carbohydrate sources
Please select foods that are available to you and enjoyed or tolerated by
your pet
White Rice
Barley
Polenta
Ground Corn
Zucchini
Brown Rice
White Potato
Millet
Green peas
Lentils
Oatmeal
Sweet Potato
Couscous
Carrots
Broccoli
Pasta/Spaghetti
Pasta, other
Quinoa
Tapioca
Squash, yellow
Cauliflower
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Please list any other
sources of carbohydrates
you'd like to include
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Please list any foods you want
like to avoid
feeding
your pet
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Finish
You've completed the
pre-consultation form!
You should receive a confirmation e-mail shortly.
If you don't see the e-mail, please check your spam or contact us.
What happens next?
Forward Veterinarian Referral Link
You'll recieve an email with a link to a veterinary referral form shortly.
You'll need to forward this email to your referring veterinarian so they can fill it out.
Pertinent Medical Records
These should be sent by your veterinarian when they fill out the vet referral form. This should include all pertinent medical records from your referring veterinarian including a CBC, chemistry, T4 and urinalysis performed within the last 6 months.
If your pet's labwork is not up-to-date, you'll need to schedule an appointment with your primary veterinarian to update your pet's records before your consultation can proceed.
Follow Up Prior to Consultation
After receving your medical records, Dr. Foster will reach out to you directly for any additional information that may needed.