Client Pre-Visit Intake

CLIENT PRE-VISIT PORTAL SUBMISSION IMPORTANT: Client-submitted information is unverified until clinician review. Physical food, treat, supplement and medication samples/packages were requested for RAC testing and label verification. OWNER / PATIENT Owner: Hillian Email: Phone: Patient: Hustle Species: Breed: Sex / desexed status: Age: Weight kg: EXISTING CLIENT / PATIENT MATCHING DETAILS Previous client?: Yes Alternate / partner owner name: No Possible registered owner: Previous patient name: PRIMARY CONCERN HISTORY / TIMELINE DIET Big dog sensitive TREATS / CHEWS / SNACKS SUPPLEMENTS MEDICATIONS / HERBS / TOPICAL PRODUCTS ENVIRONMENT / EXPOSURES LABEL / SAMPLE / RAC STATUS Label review: Awaiting review Physical sample: Bring physical label/sample required RAC sample: RAC sample pending Clinic notes: