• Date Format: MM slash DD slash YYYY
  • Animal Information

    * Please click the plus (+) icon to add more animals.
  • ID NumberHouse NameSexAgeCurrent Body Weight*Current Body Condition* 
    *Current body weight in grams or kilograms. Current body condition on scale from 1 to 5, where 1 is emaciated, 3 is ideal, and 5 is obese.
  • Enter ID Number:Spayed/Neutered (y/n)Chemical birth control (y/n)Reproductively active (y/n) 
  • Animal IDCondition/DiseaseDate DiagnosedMedication Name, Dose, Route, Freq. 
  • Instructions for the following questions: Be sure the “Amount” provided is measurable. Always weigh the measured amount of food on a gram scale and provide the total gram weight for each ingredient.

    Possible scenarios to troubleshoot:

    • Unlabeled cup or scoop: First measure the amount held in that cup/scoop - for example, “½ scoop” may actually represent a true 1 cup, as measured. Then weigh the volume of diet item held within that container.
    • Abstract unit of measure (e.g. “one handful”), take one handful of the item and obtain the gram weight of that handful 5 days in a row. If different individuals are doing the feeding, make sure that each individual’s handful is represented. Then calculate the average weight (grams) per handful by summing the gram weights from each of the 5 days, and diving by 5. Provide that average weight as the “Amount” below.
    • Hay/browse: For each type of hay/browse item, use either hook scale or flat platform scale and obtain average weight over 5 days.
  • ManufacturerProduct NameForm AmountFrequency 
  • Producer/DistributorStateType of HayAmountFrequencyMonths Offered 
  • Food itemPreparationAmount/Weight (grams)Freq per dayDays per week 
    Please provide information on how the food is prepared (whole vs. chopped, cooked vs. raw, live vs. frozen/thawed, etc.), food item gram weights and measured amounts, frequency offered per day, and days fed per week
  • Food itemPreparationAmount/Weight (grams)FrequencyMonths offered 
  • Please describe how water is provided (water dish, water bottle, soaking food items, automatic filler etc.).
  • ManufacturerTypeDoseFrequency