Lifestyle History Form

Phone

Date Form Completed *

Family Name *

Pet's Name *

Food Info

Food (brand and/or flavor) *

Canned/Dry or Both *

Amount per Day (in cups/oz) *

Treats (types and amount) *

If you feed dry, what size/type of measuring device do you use?

Do you give year round Heartworm Preventative? *

Yes

Brand of Heartworm

My Pet Goes To:

Boarding

Grooming

Daycare

Dog Park

Camping/Forest

Other

If Other please specify

Do you give any dietary supplements (vitamins, fish oil)? *

Yes

If Yes, please list

Do you apply Flea and Tick medication? *

Yes

Brand of medication

For Cats:

Indoor Only

Outdoor Only

Indoor/Outdoor

Boarding

Grooming

If your pet travels outside of Illinois, please list place(s)

Please describe the type and amount of exercise your pet receives daily/weekly *

7:30am - 6:00pm Mon, Tue, Thur, & Fri,
7:30am - 5:00pm Wed
8:00am - 1:00pm Sat

847.526.2727

197 Thomas Court | Wauconda, IL 60084-2450
Fax 847.526.8059