Commercial Food Matching Intake NOTE: There is a "Save Draft" option all the way at the bottom. Please consider saving occasionally especially if you have to walk away. This form works best on a computer rather than mobile. If you have to use a mobile device, do not let your device go to sleep or you will loose all data. If you need help accessing your draft, please email me at hello@tailoredtummyco.com *Check to confirm you read!Name *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 *EmailText (only available to US clients)Phone *How many dogs will be included? *Choose one12345About Your Dog #1Dog's Name *Breed *Birthday *Sex *Male- NeuteredMale- IntactFemale- SpayedFemale- IntactCurrent Weight *Units *LBKGHow would you rate their BCS? *1- Ribs, spine and hip bones are visible from a distance. No discernible body fat and an obvious loss of muscle mass.2- Ribs, spine and hip bones are easily visible. No palpable body fat and minimal loss of muscle mass.3- Ribs can be easily felt and may be visible with no palpable fat. Top of the spine is visible and hip bones may also be prominent.4- Ribs can be easily felt with minimal fat covering. Waist is easily noted when viewed from above. An “abdominal tuck” is also present5- Well-proportioned. Ribs can be easily felt without excess fat covering. Waist can be observed behind the ribs when viewed from above. Abdominal tuck is present.6- Ribs can be felt through a slight excess fat covering. Waist is visible from above, but not prominent. Abdominal tuck is present.7- Ribs are difficult to feel under a heavy fat covering. Noticeable fat deposits over the lower back and base of the tail. Waistline is absent or barely visible and abdomen may appear obviously rounded or saggy.8- Ribs can only be felt with heavy pressure. Significant fat deposits over the lower back and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention may also be present.9- Ribs cannot be felt under a very heavy fat covering. Large fat deposits are seen over the neck, chest, spine and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention and a broad, flat back may also be present.How would you describe their digestive health? Select all that apply *No concernsBile VomitingRegurgitationBloatingBurpingNoisy StomachGasDiarrheaConsitpationClogged Anal GlandsMucous coated stoolOff color stoolOtherPlease give as much detail as possible about any concerns that you haveHow would you describe their skin and coat health? Select all that apply. *Shiny/ Soft CoatRough CoatDull CoatHot SpotsBald SpotsRed/ Inflamed SkinItchy SkinDiscolored/ Smelly EarsExcessive SheddingOtherPlease give as much detail as possible about any concerns that you haveDo they have any previous or existing DIAGNOSED medical condition(s)? *YesNoWhat is the diagnosis, when was it and what treatment was done? *Are there any other health concerns that have not been formally diagnosed by a veterinarian or specialist? *YesNoPlease describe *Does your dog have any food sensitivities/ intolerances? *YesNoWhat are they and how were they diagnosed? *What are they currently eating? Please include as much detail as possible. Direct links are helpful *ex. Wellness Core GF Small Breed Healthy Weight Turkey KibbleDo you add any toppers or supplements? Please give as much detail as possible *How much do they eat per day? *What foods have they eaten in the past? Why did you stop feeding these? *Why are you looking to change their current diet? *About Your Dog #2Dog's Name *Breed *Birthday *Sex *Male- NeuteredMale- IntactFemale- SpayedFemale- IntactCurrent Weight *Units *LBKGHow would you rate their BCS? *1- Ribs, spine and hip bones are visible from a distance. No discernible body fat and an obvious loss of muscle mass.2- Ribs, spine and hip bones are easily visible. No palpable body fat and minimal loss of muscle mass.3- Ribs can be easily felt and may be visible with no palpable fat. Top of the spine is visible and hip bones may also be prominent.4- Ribs can be easily felt with minimal fat covering. Waist is easily noted when viewed from above. An “abdominal tuck” is also present5- Well-proportioned. Ribs can be easily felt without excess fat covering. Waist can be observed behind the ribs when viewed from above. Abdominal tuck is present.6- Ribs can be felt through a slight excess fat covering. Waist is visible from above, but not prominent. Abdominal tuck is present.7- Ribs are difficult to feel under a heavy fat covering. Noticeable fat deposits over the lower back and base of the tail. Waistline is absent or barely visible and abdomen may appear obviously rounded or saggy.8- Ribs can only be felt with heavy pressure. Significant fat deposits over the lower back and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention may also be present.9- Ribs cannot be felt under a very heavy fat covering. Large fat deposits are seen over the neck, chest, spine and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention and a broad, flat back may also be present.How would you describe their digestive health? Select all that apply *No concernsBile VomitingRegurgitationBloatingBurpingNoisy StomachGasDiarrheaConsitpationClogged Anal GlandsMucous coated stoolOff color stoolOtherPlease give as much detail as possible about any concerns that you have *How would you describe their skin and coat health? Select all that apply. *Shiny/ Soft CoatRough CoatDull CoatHot SpotsBald SpotsRed/ Inflamed SkinItchy SkinDiscolored/ Smelly EarsExcessive SheddingOtherPlease give as much detail as possible about any concerns that you have *Do they have any previous or existing DIAGNOSED medical condition(s)? *YesNoWhat is the diagnosis, when was it and what treatment was done? *Are there any other health concerns that have not been formally diagnosed by a veterinarian or specialist? *YesNoPlease describe *Does your dog have any food sensitivities/ intolerances? *YesNoWhat are they and how were they diagnosed? *What are they currently eating? Please include as much detail as possible. Direct links are helpful *ex. Wellness Core GF Small Breed Healthy Weight Turkey KibbleDo you add any toppers or supplements? Please give as much detail as possible *How much do they eat per day? *What foods have they eaten in the past? Why did you stop feeding these? *Why are you looking to change their current diet? *About Your Dog #3Dog's Name *Breed *Birthday *Sex *Male- NeuteredMale- IntactFemale- SpayedFemale- IntactCurrent Weight *Units *LBKGHow would you rate their BCS? *1- Ribs, spine and hip bones are visible from a distance. No discernible body fat and an obvious loss of muscle mass.2- Ribs, spine and hip bones are easily visible. No palpable body fat and minimal loss of muscle mass.3- Ribs can be easily felt and may be visible with no palpable fat. Top of the spine is visible and hip bones may also be prominent.4- Ribs can be easily felt with minimal fat covering. Waist is easily noted when viewed from above. An “abdominal tuck” is also present5- Well-proportioned. Ribs can be easily felt without excess fat covering. Waist can be observed behind the ribs when viewed from above. Abdominal tuck is present.6- Ribs can be felt through a slight excess fat covering. Waist is visible from above, but not prominent. Abdominal tuck is present.7- Ribs are difficult to feel under a heavy fat covering. Noticeable fat deposits over the lower back and base of the tail. Waistline is absent or barely visible and abdomen may appear obviously rounded or saggy.8- Ribs can only be felt with heavy pressure. Significant fat deposits over the lower back and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention may also be present.9- Ribs cannot be felt under a very heavy fat covering. Large fat deposits are seen over the neck, chest, spine and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention and a broad, flat back may also be present.How would you describe their digestive health? Select all that apply *No concernsBile VomitingRegurgitationBloatingBurpingNoisy StomachGasDiarrheaConsitpationClogged Anal GlandsMucous coated stoolOff color stoolOtherPlease give as much detail as possible about any concerns that you have *How would you describe their skin and coat health? Select all that apply. *Shiny/ Soft CoatRough CoatDull CoatHot SpotsBald SpotsRed/ Inflamed SkinItchy SkinDiscolored/ Smelly EarsExcessive SheddingOtherPlease give as much detail as possible about any concerns you have *Attach photos of any skin/ coat concerns you haveDrag and Drop (or) Choose FilesDo they have any previous or existing DIAGNOSED medical condition(s)? *YesNoWhat is the diagnosis, when was it and what treatment was done? *Are there any other health concerns that have not been formally diagnosed by a veterinarian or specialist? *YesNoPlease describe *Does your dog have any food sensitivities/ intolerances? *YesNoWhat are they and how were they diagnosed? Have you tried any treatments? *What are they currently eating? Please include as much detail as possible. Direct links are helpful *ex. Wellness Core GF Small Breed Healthy Weight Turkey KibbleDo you add any toppers or supplements? Please give as much detail as possible *How much do they eat per day? *What foods have they eaten in the past? Why did you stop feeding these? *Why are you looking to change their current diet? *About Your Dog #4Dog's Name *Breed *Birthday *Sex *Male- NeuteredMale- IntactFemale- SpayedFemale- IntactCurrent Weight *Units *LBKGHow would you rate their BCS? *1- Ribs, spine and hip bones are visible from a distance. No discernible body fat and an obvious loss of muscle mass.2- Ribs, spine and hip bones are easily visible. No palpable body fat and minimal loss of muscle mass.3- Ribs can be easily felt and may be visible with no palpable fat. Top of the spine is visible and hip bones may also be prominent.4- Ribs can be easily felt with minimal fat covering. Waist is easily noted when viewed from above. An “abdominal tuck” is also present5- Well-proportioned. Ribs can be easily felt without excess fat covering. Waist can be observed behind the ribs when viewed from above. Abdominal tuck is present.6- Ribs can be felt through a slight excess fat covering. Waist is visible from above, but not prominent. Abdominal tuck is present.7- Ribs are difficult to feel under a heavy fat covering. Noticeable fat deposits over the lower back and base of the tail. Waistline is absent or barely visible and abdomen may appear obviously rounded or saggy.8- Ribs can only be felt with heavy pressure. Significant fat deposits over the lower back and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention may also be present.9- Ribs cannot be felt under a very heavy fat covering. Large fat deposits are seen over the neck, chest, spine and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention and a broad, flat back may also be present.How would you describe their digestive health? Select all that apply *No concernsBile VomitingRegurgitationBloatingBurpingNoisy StomachGasDiarrheaConsitpationClogged Anal GlandsMucous coated stoolOff color stoolOtherPlease give as much detail as possible about any concerns that you have *How would you describe their skin and coat health? Select all that apply. *Shiny/ Soft CoatRough CoatDull CoatHot SpotsBald SpotsRed/ Inflamed SkinItchy SkinDiscolored/ Smelly EarsExcessive SheddingOtherPlease give as much detail as possible about any concerns that you have *Do they have any previous or existing DIAGNOSED medical condition(s)? *YesNoWhat is the diagnosis, when was it and what treatment was done? *Are there any other health concerns that have not been formally diagnosed by a veterinarian or specialist? *YesNoPlease describe *Does your dog have any food sensitivities/ intolerances? *YesNoWhat are they and how were they diagnosed? *What are they currently eating? Please include as much detail as possible. Direct links are helpful *ex. Wellness Core GF Small Breed Healthy Weight Turkey KibbleDo you add any toppers or supplements? Please give as much detail as possible *How much do they eat per day? *What foods have they eaten in the past? Why did you stop feeding these? *Why are you looking to change their current diet? *About Your Dog #5Dog's Name *Breed *Birthday *Sex *Male- NeuteredMale- IntactFemale- SpayedFemale- IntactCurrent Weight *Units *LBKGHow would you rate their BCS? *1- Ribs, spine and hip bones are visible from a distance. No discernible body fat and an obvious loss of muscle mass.2- Ribs, spine and hip bones are easily visible. No palpable body fat and minimal loss of muscle mass.3- Ribs can be easily felt and may be visible with no palpable fat. Top of the spine is visible and hip bones may also be prominent.4- Ribs can be easily felt with minimal fat covering. Waist is easily noted when viewed from above. An “abdominal tuck” is also present5- Well-proportioned. Ribs can be easily felt without excess fat covering. Waist can be observed behind the ribs when viewed from above. Abdominal tuck is present.6- Ribs can be felt through a slight excess fat covering. Waist is visible from above, but not prominent. Abdominal tuck is present.7- Ribs are difficult to feel under a heavy fat covering. Noticeable fat deposits over the lower back and base of the tail. Waistline is absent or barely visible and abdomen may appear obviously rounded or saggy.8- Ribs can only be felt with heavy pressure. Significant fat deposits over the lower back and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention may also be present.9- Ribs cannot be felt under a very heavy fat covering. Large fat deposits are seen over the neck, chest, spine and base of the tail. Waist and abdominal tuck are both absent. Obvious abdominal distention and a broad, flat back may also be present.How would you describe their digestive health? Select all that apply *No concernsBile VomitingRegurgitationBloatingBurpingNoisy StomachGasDiarrheaConsitpationClogged Anal GlandsMucous coated stoolOff color stoolOtherPlease give as much detail as possible about any concerns that you have *How would you describe their skin and coat health? Select all that apply. *Shiny/ Soft CoatRough CoatDull CoatHot SpotsBald SpotsRed/ Inflamed SkinItchy SkinDiscolored/ Smelly EarsExcessive SheddingOtherPlease give as much detail as possible about any concerns that you have *Do they have any previous or existing DIAGNOSED medical condition(s)? *YesNoWhat is the diagnosis, when was it and what treatment was done? *Are there any other health concerns that have not been formally diagnosed by a veterinarian or specialist? *YesNoPlease describe *Does your dog have any food sensitivities/ intolerances? *YesNoWhat are they and how were they diagnosed? *What are they currently eating? Please include as much detail as possible. Direct links are helpful *ex. Wellness Core GF Small Breed Healthy Weight Turkey KibbleDo you add any toppers or supplements? Please give as much detail as possible *How much do they eat per day? *What foods have they eaten in the past? Why did you stop feeding these? *Why are you looking to change their current diet? *Food RecommendationsWhat are some of your goals with the new diet(s)?What type(s) of diet do you prefer? *Select all that applyKibbleCannedFreeze-DriedAir-DriedFrozen RawFrozen CookedIf you selected more than one option above, how do you envision the diet?Ex. canned food just as a topperIf you have certain brands/ foods in mind, share them hereAre there certain flavors your dog(s) prefer over others? *Are there certain flavors your dog(s) dislike?Do you have certain stores (online or in person) that you would prefer to shop at?If using small neighborhood stores, I may need you to confirm availability and priceWhat is your monthly budget for your dogs diet?I do my best to stay under budget when possible. If you are sourcing from stores that don't have their prices available online, I may need you to relay prices if the budget is important.If anyone in your household has food allergies that need to be avoided, please list them here.ex. GlutenConclusionIs there anything else you want me to know?How did you hear about me?Disclaimer and Assumption of Risk *By purchasing and using this formulation, you acknowledge that it has been created by a canine nutrition professional for use as a balanced, homemade diet. You understand and accept that all risks associated with feeding, preparing, and storing a home-prepared diet are your responsibility as the dog’s owner.Tailored Tummy Co. does not provide any guarantees or warranties, express or implied, regarding the formulation or its expected outcomes. It is solely your responsibility to determine whether this recipe is appropriate for your dog, based on their individual needs and in consultation with your veterinary care provider.If you choose to include raw meaty bones as part of the diet, you acknowledge and accept all associated risks, including but not limited to tooth fractures, gastrointestinal obstruction, or other injuries. Tailored Tummy Co. does not formulate using weight-bearing bones from large animals due to the increased risk of harm.You also understand that Ashlyn Van Buren, d/b/a Tailored Tummy Co., is not a veterinarian and that this service does not replace proper veterinary care. It is your responsibility to share relevant health information about your dog with both Tailored Tummy Co. and your veterinary team.Refunds and Reformulations *Yes, I agree with the Refund and Reformulations PolicySubmitSave as DraftPlease do not fill in this field.
