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[\/et_pb_text][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”||50px||false|false” global_colors_info=”{}”]Please complete this form prior to a Nutrition Consult[\/et_pb_text][et_pb_contact_form use_spam_service=”on” recaptcha_list=”JAWS 4049|JAWS 4049-0″ email=”diethistory@joseesanimalwellness.com” custom_message=”%91subject%93 Dietary History %%pet-name%% Form%91\/subject%93||et_pb_line_break_holder||Owner’s full name: %%Name%%||et_pb_line_break_holder||||et_pb_line_break_holder||Pet’s name: %%pet-name%%||et_pb_line_break_holder||||et_pb_line_break_holder||Species\/Breed: %%species-breed%%||et_pb_line_break_holder||||et_pb_line_break_holder||Pet’s age: %%pets-age%%||et_pb_line_break_holder||||et_pb_line_break_holder||Current body weight: %%pets-bodyweight%%||et_pb_line_break_holder||||et_pb_line_break_holder||Sex: %%sex%%||et_pb_line_break_holder||||et_pb_line_break_holder||Spayed\/Neutered: %%spayed%%||et_pb_line_break_holder||||et_pb_line_break_holder||How active is your pet: %%activity-level%%||et_pb_line_break_holder||||et_pb_line_break_holder||How would you describe your pet’s weight: %%weight-description%%||et_pb_line_break_holder||||et_pb_line_break_holder||Where does your pet spend most of its time: %%time-spent%%||et_pb_line_break_holder||||et_pb_line_break_holder||Please list brands, prodcts and amount of ALL foods, treats, snacks, dental hygiene products, rawhides and any other foods that your pet currently eats: ||et_pb_line_break_holder||%%products-used%%||et_pb_line_break_holder||||et_pb_line_break_holder||What size measuring device do you use: %%measuring-device%%||et_pb_line_break_holder||||et_pb_line_break_holder||If you feed canned food, what size cans: %%canned-food-size%%||et_pb_line_break_holder||||et_pb_line_break_holder||Do you give any dietary supplements to your pet?: %%dietary-suplements%%||et_pb_line_break_holder||||et_pb_line_break_holder||Supplements list: %%dietary-suplements-list%%” success_message=”Your message has been sent successfully!” submit_button_text=”Send” _builder_version=”4.27.4″ _module_preset=”default” _unique_id=”c9110bcc-6c8a-4e35-8d90-81bc4a0feb32″ form_field_background_color=”#FFFFFF” custom_button=”on” button_text_size=”18px” button_text_color=”#FFFFFF” button_bg_color=”gcid-b77800f7-981e-4e7c-b867-0a0e549b961c” button_border_color=”gcid-b77800f7-981e-4e7c-b867-0a0e549b961c” button_border_radius=”8px” button_use_icon=”off” hover_enabled=”0″ border_radii=”on|5px|5px|5px|5px” border_width_all=”2px” border_color_all=”gcid-b77800f7-981e-4e7c-b867-0a0e549b961c” global_colors_info=”{%22gcid-b77800f7-981e-4e7c-b867-0a0e549b961c%22:%91%22button_bg_color%22,%22button_border_color%22,%22border_color_all%22%93}” sticky_enabled=”0″ recaptcha_min_score=”0.3″][et_pb_contact_field field_id=”Name” field_title=”Owner’s Full Name” 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field_id=”pet-name” field_title=”Pet’s Name” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”species-breed” field_title=”Species\/Breed” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”pets-age” field_title=”Pet’s Age” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”pets-bodyweight” field_title=”Current Body Weight” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”sex” field_title=”Sex” field_type=”radio” radio_options=”%91{%22value%22:%22Male%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Female%22,%22checked%22:0,%22dragID%22:0}%93″ fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”spayed” field_title=”Spayed\/Neutered” field_type=”radio” radio_options=”%91{%22value%22:%22Yes%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22No%22,%22checked%22:0,%22dragID%22:0}%93″ fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”activity-level” field_title=”How Active Is Your Pet” field_type=”radio” radio_options=”%91{%22value%22:%22Very Active%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Moderately Active%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Not Very Active%22,%22checked%22:0,%22dragID%22:1}%93″ fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”weight-description” field_title=”How Would You Describe Your Pet’s Weight” field_type=”radio” radio_options=”%91{%22value%22:%22Overweight%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Ideal Weight%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Underweight%22,%22checked%22:0,%22dragID%22:1}%93″ fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”time-spent” field_title=”Where Does Your Pet Spend Most of Its Time” field_type=”radio” radio_options=”%91{%22value%22:%22Indoors%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Outdoors%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Both%22,%22checked%22:0,%22dragID%22:1}%93″ fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”products-used” field_title=”Please list the brands, product names and the amount of ALL foods, treats, snacks, dental hygiene products, rawhides and any other foods that your pet currently eats, including foods used to administer medications:” field_type=”text” fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”measuring-device” field_title=”What Size Measuring Device Do You Use” fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”canned-food-size” field_title=”If You Feed Canned Food, What Size Cans” fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”dietary-suplements” field_title=”Do You Give Any Dietary Supplements To Your Pet (example: vitamins, glucosamine, fish oils)” field_type=”radio” radio_options=”%91{%22value%22:%22Yes%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22No%22,%22checked%22:0,%22dragID%22:0}%93″ fullwidth_field=”on” _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][et_pb_contact_field field_id=”dietary-suplements-list” field_title=”If yes, please list what supplements are given and in what amount\/frequency.” required_mark=”off” fullwidth_field=”on” conditional_logic=”on” conditional_logic_rules=”%91{%22field%22:%22dietary-suplements%22,%22condition%22:%22is%22,%22value%22:%22Yes%22}%93″ _builder_version=”4.27.2″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
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