Proactive Senior Intake Form

Proactive Senior Intake Form

Please provide as much detail as possible and allow yourself 15-20 minutes to complete the form. There are three pages.
Name *

First Name Last Name
Email *
example@example.com
City/Country *
Dog's name: *
Dog's age: *
How long have you owned your dog? *
Dog's breed: *
Dog’s weight in lbs.? Do you consider your dog to be at a healthy weight? *
Dog's ideal weight: *
Dog's sex: *
Dog's status: *

Spayed/neutered Intact
When was the last time your dog has seen a vet, and what was the reason for the visit? *
Has your dog been diagnosed with any diseases/conditions? If so, please list them and the year of diagnosis if possible. *
When was the last time you had bloodwork or other diagnostics (x-rays, urinalysis) performed on your senior dog? *
Is your dog currently on any veterinarian-prescribed medications? If yes, please list the medications and the dosages. *
How is the condition of your dog’s skin, ears, coat, breath, and teeth? *
What is your dog’s activity level? Please be specific. *
Does your dog experience stressful situations frequently, such as traveling or boarding? If yes, please explain. *
Is your dog primarily indoor or outdoor? *
Is your dog exposed to many chemicals, such as household cleaners, pesticides, weed killer, etc.? Would you say that your dog has had a history of being exposed to these every day items? *
How frequent does your dog drink? What kind of water (i.e. tap, bottled, reverse osmosis, etc.)? *

Have you noticed any changes in your dog's behavior, such as increased anxiety, increased sleepiness/sleeplessness, or going to the bathroom inside? *
Have you noticed your dog becoming less tolerant of heat or exercise? This may include behaviors like coughing/hacking after exercise; change in length of time your wants to or is able to play; or needing longer periods of time to recuperate. *
Have you noticed any changes in bathroom habits, such as mucus in the stool, diarrhea, increased urination, incontinence, or constipation? *
Are there any changes to your dog's posture, gait, or ability to otherwise move that may indicate arthritis? Does your dog have any history of injury to muscles/ligaments? *
Have you noticed any changes to your dog's skin or coat, such as lumps (like lipomas), dry skin, brittle or dulling coat, itchiness, or the presence of yeast? *
How is your dog’s appetite? Are they on a specific feeding schedule? *
Is your dog showing any signs of digestive upset on their current diet- diarrhea, constipation, vomiting, lip licking? *

What are you currently feeding your dog, and how much are they eating total every day? *
How long have you been feeding your dog their current diet? *
What kind of treats and chews are you giving your dog? How often? *
Do you provide any supplements in your dog’s diet? Supplements include things like multivitamins, herbs, goat milk, etc. If you already have vitamin and mineral supplements on hand, please list the brand and dosage so that I can include them in the recipes if needed. *
Does your dog have any known or suspected food allergies or intolerances? If yes, to which foods is your dog allergic/intolerant? *
What kind of bowl is your dog eating and drinking out of (metal, ceramic, plastic, etc.)? *
If you can, please specify particular cuts of meat (pork loin vs. pork shoulder; chuck roast vs stew chunks; etc.) that you have available. Do not write "any cut available"- at the very least, provide protein sources. Is there anything, whether it be protein source or particular cut of meat, that you do not have available? *
Note: Please make sure items here are readily affordable and available. Adjustments due to miscommunication of ingredients can take longer.
If seafood is available and affordable for you, we can typically use them in the place of some supplements. Do you have seafood (fish, mussels, oysters, shrimp, etc.) available to you? If yes, please specify what kind (i.e., salmon vs. mackerel) and if it is raw/fresh or canned. *
Are there any co-ops or online raw food resources that you utilize to source food items? If yes, please provide links to these. *
Do you have a preferred place or website to buy supplements? If yes, please list them. *
What are your goals for providing your dog a homemade diet? *
Do you consider yourself a beginner, or more of a seasoned homemade feeder? How much detail and depth would you like for instructions? *
Please add anything else about your dog that you would like for me to take into consideration. I enjoy reading about your dog, so feel free to be as detailed as you like!
Please attach any medical and/or nutrition document, as well as any photos of your dog that you feel are relevant to the case (body condition, sores, rashes, etc.).

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Terms and Conditions

You understand and accept that this diet formulation is completed by a canine nutrition professional; you agree to assume all risks involved with feeding, preparation, storage; you understand that Fed to Thrive is not a substitute for veterinary advice and/or care; and that you, the owner, are responsible for any consequences that may occur from a home prepared diet including adverse reactions. Fed to Thrive does not provide any guarantee or warranty on the recipes or for expected results. It is the owner/feeder's responsibility to determine if the recipe is right to feed their dog. Additionally, you release all submitted images and data. In the event that your dog is utilized for a case study, all data will be kept anonymous.

Recipe must be prepared and followed as written for support period to be valid. Substitutions, errors during preparation, undisclosed animal heath conditions, failure to diclose pertinent information, and low ingredient quality can all be reasons for desired results to not be achieved.

Owner understands that while raw meaty bones are a common part of the healthy adult dog's diet, they are often contraindicated in the diet of the senior dog. If any owner insists on the inclusion of raw meaty bones after being advised against them, the recipe will include a disclaimer stating that the RMBs are included against guidance. If you choose to feed raw meaty bones, Fed to Thrive cannot be held liable for any issues that may arise (i.e. fractured teeth, elevated kidney enzymes as a result of high phosphorus, etc.).

Issues due to ingredient miscommunication or market availability fall outside of the scope of free adjustments. Time slots for adjustments due to these reasons can be purchased but are always scheduled on Saturdays and cannot be done immediately. It is your responsibility to make sure that the ingredient availability information you have provided is accurate. You will recieve an e-mail with a proposed ingredient list that allows us to finalize ingredients before completion.

Recipe support period is two weeks (14 business days) OR 10 e-mails from Chelsea/dba Fed to Thrive. Additional support time can be purchased. Recipe support begins upon delivery of the recipe(s) unless specifically discussed ahead of time.

Basic ingredient information can be shared on social media but recipe amounts/custom recipe information/documents given to you by Chelsea McGinnis/dba Fed to Thrive cannot be shared between anyone but you and your dog's healthcare professionals.

The recipe(s) you receive are custom-tailored for the stated dog. Any recipes broken down/adjusted for other household dogs without assistance from Fed to Thrive are not guaranteed to be balanced.

Current turnaround time for proactive senior recipes is 14 business days unless stated otherwise.
Please provide an e-signature to confirm that you have read and agree to the above terms and conditions.

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