Susan G. Wynn, DVM, CVA, CVCH, AHG   
Veterinary Nutrition and Integrative Medicine  
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Patient history forms
How to get a consultation:
We work directly with your veterinarian to develop a customized diet plan based on your pet's medical history and food preferences, along with your ability to source diet ingredients locally or on the web.  

The evaluation of a patient for a customized diet requires physical and historical information, such as the current body condition (fat and muscle in standard scoring systems), medical history, and an understanding of the pet's food preferences as well as the owner's preferences about the type of diet they can provide. In order to fully evaluate a pet's nutritional needs, we require:

1. A referral from your veterinarian
2. Our patient history paperwork to be filled out fully

Unfortunately, we cannot consult directly with pet owners, as this is illegal. Most state practice acts (the law that governs veterinarians and their practices) require a valid "veterinarian-client-patient relationship" (or VCPR).  A VCPR is established when a veterinarian becomes familiar with your pet, starting with a physical examination, and maintained by communications between the owner and doctor, and physical examinations at least yearly (and more for sick animals). Because we are unable to establish a valid VCPR without personally examining your pet, our consultation, payments, and follow-up communications are with your veterinarian. 

Phone consultations:
If your pet is a current patient of the nutrition and integrative medicine service at BluePearl GVS, we can sometimes offer phone consultations after the initial, in-person, evaluation.  

Get started:
If you would like a homemade diet formulated, please click the link below, fill out Part 2, which begins on page 3, then send the form to your veterinarian to complete and fax, email or mail to us. 

Nutrition History Form
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