About YouName *Email Address *City *State/Province *ZIP / Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePreferred method of communication *Please select an optionEmailText (US only)Phone *About Your DogAbout Your DogDog's Name *Dog's Breed *Dog's Birthday *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212621252124212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926Dog's Sex *Select oneFemale- IntactFemale- SpayedMale- IntactMale- NeuteredDog's Weight *Please list any past weight records (with age or the date they were recorded) for your puppy. The more data points the better for growth charting! *If you have any information on your puppy's parents, please include it here. *Dog's BCS *Please see the chart at www.tailoredtummyco.com/bcs123456789Has your dog's vet given you information on your dog's ideal weight? *How long have you owned your dog? *Is there anything from your dog's past that you feel is important for me to know? *How much exercise, on average, does your dog get daily? *Less than 1 hour1-2 hours2-4 hours4+ hoursWhat type(s) of exercise does your dog get daily? *How often does your dog drink water? What type? *How would you describe your dogs normal bowel movements? *1234567Does your dog ever have constipation or diarrhea? How long did it last? Have they ever been to the vet for this issue? What was the result of the visit? *Does your dog ever vomit? Please describe how often, what time of day and what type (ie. hunger pukes, vomiting food, vomiting water etc.). Have they ever been to the vet for this issue? What was the result of the visit? *How is your dogs coat? Is it shiny, dull, soft, rough etc? Do they have any red spots or bald patches? *Does your dog ever scratch, chew, bite and/or lick themselves? Please describe what area of the body and if there is a certain time of year it occurs. *Have you tried any sort of treatment for any skin conditions? What were they? *How do your dog's ears look? Any discoloration, discharge, smell, etc.? *How do your dog's teeth look? *Medical HistoryDoes your dog have any previous or existing DIAGNOSED medical condition? *Select oneYesNoWhat is the diagnosis? *How long has it been since the diagnosis? What was done for treatment?Are there any other health concerns that have not been formally diagnosed by a veterinarian/ specialist? *Select oneYesNoPlease describeIs your dog currently taking any medication, either prescription or non-prescription? *Select oneYesNoPlease list all medications- brand, name and doseHas your dog ever been diagnosed with any food sensitivities/ intolerances? *Select oneYesNoWhat are they and how were they diagnosed?Has your dog ever been diagnosed with environmental allergies? *Select oneYesNoWhat are they and how were they diagnosed? What treatment has been done, if any?Is your dog on flea and tick and/or heartworm preventative? *Select oneYesNoPlease list brand and frequencyCurrent DietPlease list every ingredient used in the dog's current diet WITH the amounts of each fed. If the diet consists of rotating ingredients, please give a few different examples of typical meals. Be sure to also specify what protein each ingredient is from. For example, 10g chicken liver, NOT 10g liver. *How much are they eating per day in total (in grams) OR how long does the batch described above last? *Please list brand, name, dose and how much is given daily of any supplements you add. If you are feeding a homemade diet, I need to know every non-food item added to the diet. Links are useful as well *ConclusionNOTE: If you upload any pictures/ files and save as a draft before submitting the form, you will need to re-upload the files!Please upload the following 3 pictures! 1 front facing, 1 from the side and 1 from the top down *Drag and Drop (or) Choose FilesIs there anything else you want me to know?How did you hear about me?Assumption of Risk *You understand and accept that this diet formulation is completed by a canine nutrition professional; you agree to assume all risks involved with feeding, preparation, storage and that you, the owner, are responsible for any consequences that may occur from a home prepared diet including adverse reactions. Tailored Tummy Co. does not provide any guarantee or warranty on the recipes or for expected results. It is the owner/feeder's responsibility to determine if the recipe is right to feed their dog. Should you decide to include raw meaty bones, you are assuming all risk that comes with them. Tailored Tummy Co. cannot be held liable for any issues that may arise including but not limited to tooth fractures or GI blockages. I will not use any weight bearing bones from larger animals that pose a greater risk of injury. I understand that Ashlyn Van Buren d/b/a Tailored Tummy Co. is not a substitute for proper veterinarian care. It is your responsibility to relay pertinent information regarding your dog's health with both myself and your veterinary team.Support Period *Recipes must be prepared and followed as written for the support period to be valid. No reformulations will be made if it is determined that you are not following the recipe properly. Substitutions, errors during preparation, undisclosed animal health conditions, failure to disclose pertinent information, and low ingredient quality can all be reasons for desired results to not be achieved.Confidentiality *Recipe amounts, custom recipe information and documents given to you by Tailored Tummy Co. cannot be shared between anyone but you and your dog's veterinary professionals unless express permission is granted. Recipes formulated for your dog are intellectual property of Tailored Tummy Co. and should not be reproduced or modified for publishing or sale. Violating this section of the terms & conditions will result in the termination of our working relationship.Refunds and Reformulations *Yes, I agree with the Refunds and Reformulations PolicyPicture ReleaseI consent to my dog's pictures being used on social media for marketing and/or success stories on Tailored Tummy Co. If you don't check the box, they will only be used in your formulation report!SubmitSave as Draft
