Hill's Veterinary Nutritional Consultation Service

1
Clinic Name* This field is required.
2
State* This field is required.
Please Select
Please Select
QLD
NSW
ACT
VIC
TAS
SA
WA
NT
NZ
Choose State or NZ
3
Veterinarian Requesting Consultation* This field is required.
First Name
Last Name
4
Clinic phone number* This field is required.
Area Code
Phone Number
5
Clinic email* This field is required.
6
Patient Name* This field is required.
Pet Name
Last Name
7
Species* This field is required.
Canine
Feline
8
Breed* This field is required.
9
Age * This field is required.
If less than one year, please type in age in months ie, 6 months
10
Sex* This field is required.
M
MN
F
FS
11
Ideal Weight(kgs)* This field is required.
12
Current Weight(kgs)* This field is required.
13
Current Diet Brand* This field is required.
Hill's
Royal Canin
Blackhawk
Prime100
Lyka
Homecooked
Supermarket
Other
14
Specify Diet* This field is required.
15
List medical conditions:* This field is required.
16
Please list medication (if applicable)
17
What is your dietary enquiry* This field is required.
18
Attach History or pathology results (Can add multiple up to 100MB each in size) Please upload files to this form only and do not email them separately if you do not upload any history your consult request will be rejected* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 97.7MB
Cancelof
19
Please choose the next available date and time. Dates and times will be greyed out if unavailable use the arrows to find the next available day and time. * This field is required.
20
Additional call availability comments (ie, Only work Thurs/Fri, In consults most mornings, etc.)
21
You agree* This field is required.
By ticking the box, I confirm that the information Hill's provides me through VCS must be interpreted in line with and used on my own professional judgement and clinical experience. By submitting the form, I acknowledge that any personal information collected on this form will be used by Hill's Pet Nutrition Pty Ltd for the purpose of processing my request for VCS, and consistent with Hill's privacy policy (https://www.hillspet.com.au/legal-statement-and-privacy-policy). I understand that you may not be able to provide me with the relevant services if I decide not to provide you (or your service provider) with the necessary personal information. I further understand that I may request access to, removal, and correction of my information by contacting Hill’s at privacy_officer_hills_australia@hillspet.com
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