Phone Number

Email Address

Zip Code

Pet's Information

Pet's Name

Breed

Weight:

Activity Level

Select

Gender

Birthday (00/00/0000)

Age

Spayed/Neutered

If yes, what age?

Dog or Cat?

Current Diet & Supplements

Current Symptoms

For example: itchy skin, licking paws, digestive issues, etc.

Current Behavior

For example: anxiety, excessive thirst, fatigue, pacing, excessive panting, etc.

What is your greatest concern for your pet?

Multi-Pet Households

Do you have any other pets in your household that would benefit from diet and or supplement recommendations?

Additional Pet Info (Name, Breed, Weight, Age, sex, spay/neuter)

Health Concerns of Additional Pets

Medical Disclaimer-Multi-Pet Households

Diet and Supplement formulations are made specifically for each pet in the household. Giving another pet the same diet (whether in the same household or to a friend or family member's pet) may lead to health or nutrient deficiencies. I understand that I can't share diet plans:

Veterinarian Information

Veterinarian Contact Information

Please include name, phone number and/or email.

Please email or review any diet/supplement information with your vet you receive from me.

Veterinarian Diagnosis

Has your pet been diagnosed with a disease or health concern? For Example: Allergies, Kidney Disease, Heart Disease, Joint Disease, Dental Disease, etc. If your pet has not been diagnosed please write "Healthy" in this space.

Traditional Treatments Received

Please include all information pertaining to traditional treatments received. For example: Apoquel, Cytopoint, Steriods, Antibiotics etc. Include product name and length of time on treatment if possible.

Pet Nutrition Plan Choice

Customize your pet nutrition consultation by requesting a 60 min consultation and then click the boxes below to request additional services. If you would like to purchase a Wellness Package please note these packages include all of the services listed below.

Pet Nutrition Services

To review Wellness Packages visit this portion of my page under "services." Additional costs may be applied based on time/requests made by a client during a consultation.

Medical Disclaimer

I understand that the information on this site is not intended or implied to be a substitute for professional veterinarian advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. You are encouraged to confirm any information obtained from or through this web site or any information received from Wells Pet Nutrition with other sources, and review all information regarding any medical condition or treatment with your Veterinarian. NEVER DISREGARD PROFESSIONAL VETERINARIAN ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH WELLS PET NUTRITION OR THIS WEB SITE.

Cancellation Policy

If you need to cancel your appointment, I respectfully request at least 72 hour notice to avoid a cancellation fee ($50). Clients have the opportunity of filling their appointment time slot with a personal friend or family member. If there is an emergency, please reach out to me as soon as you can to discuss options available.

Request a Wellness Appointment/New Clients