[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-163394-105":53,"doc-detail-163394-en":124},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":117,"head_meta":119,"extra_data":121,"updated_unix":123},105,"en","diethxhamper-pet-diet-history-questionnaire","DietHxHamper - Pet Diet History Questionnaire","","Pet diet history questionnaire for a dog, requesting detailed information to support veterinary dietary assessment. Collects housing and activity level, feeding routines, access to other pets’ foods and unmonitored food sources, current and past medical problems, medications in use and recently administered, and how medications are given. Captures recent diet changes, complete current and previous diets/supplements, weight or GI signs, urination/drinking/defecation/appetite changes, allergies or chewing/swallowing difficulty, and dietary preferences and restrictions including tolerated protein and carbohydrate options.",{"@graph":63,"@context":116},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/diethxhamper-pet-diet-history-questionnaire/163394/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/diethxhamper-pet-diet-history-questionnaire/163394.png","ImageObject",442,249,{"name":88,"@type":89},"Margaret","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-27","2026-08-31",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,110,113],{"name":106,"@type":107,"acceptedAnswer":108},"What information does the questionnaire collect about my dog’s daily feeding routine?","Question",{"text":60,"@type":109},"Answer",{"name":111,"@type":107,"acceptedAnswer":112},"How does the form request medication and supplement details?",{"text":60,"@type":109},{"name":114,"@type":107,"acceptedAnswer":115},"What dietary changes, symptoms, and allergy-related information are covered?",{"text":60,"@type":109},"https://schema.org",{"og:url":78,"og:type":118,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":120,"canonical":78},"index,follow",{"doc_id":122,"site_id":56},163394,1788143075,{"code":4,"msg":5,"data":125},{"doc_id":122,"user_id":126,"nickname":88,"user_avatar":127,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":128,"file_id":129,"file_url":130,"file_type":131,"file_size":132,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":133,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":134,"faqs":135,"seo_title":136,"seo_description":61,"update_tm":123,"read_time":73},137451207643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Beth Hamper, DVM, PhD, DACVN\nVCA Advanced Veterinary Care Center 7712 Crosspoint Commons\nFishers, IN 46038\nBeth.hamper@vca.com\nPlease answer the following questions regarding your dog\nDate______________________________   Pet’s Name_______________________\nBreed_____________________________   Date of Birth _____________________\nGender ___________________________   Neutered/spayed   No \u0013 FORMCHECKBOX \u0014\u0015  Yes \u0013 FORMCHECKBOX \u0014\u0015\n1. Is your pet housed:   ( Indoor   ( Outdoor   ( Both\n2. Please describe your pet’s activity level (i.e. type, duration & frequency):\n3. Do you have other pets?  ( Yes  ( No  \tIf yes, please list:\n4. Does your pet have access to other pet’s foods?  ( Yes  ( No  If yes, please describe:\n5. Is food left out for your pet during the day or taken away after the meal?\n6. Does your pet have access to other unmonitored food sources (i.e. food from a neighbor, dog food etc.)?   ( Yes  ( No  If yes, please describe:\n7. Who typically feeds your pet?\n8. How do you store your pet’s food?\n9. Please list your pet’s current and past medical problems, if any, and whether they have resolved:\nPage 1 of 4\n10. Please list all medications your pet is currently receiving and any administered over the past three months (indicate those that are current):\n11. How do you administer medications and supplements to your pet? If foods such as peanut butter or Pill Pockets are used, please estimate amounts fed per day.\n12. Have you made any recent changes in the diet (i.e. the last 4 weeks)? No \u0013 FORMCHECKBOX \u0014\u0015 Yes \u0013 FORMCHECKBOX \u0014\u0015\nIf yes, please describe what the change was and why you made it ______________________________\n_________________________________________________________________________________________________________\n13. Current Diets\nPlease list below the brands and product names (if applicable) and amounts of ALL foods, treats, snacks, dental hygiene product, and any other foods that your pet is currently eating.   Please separate out each ingredient in a home-cooked diet, listing each ingredient on its own line.\nThis description should provide enough detail that we could go to the store and purchase the food. It should include human foods given as treats or at the table. Examples given in italics.\nPlease list the name of each additional supplement your pet receives, indicate how much and how often your pet receives it (i.e. herbal product, fatty acid, vitamin or mineral supplement): \t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t_________________________________________________________________________________________________________\n14. Previous Diets and Supplements\nPlease list other diets, treats, and supplements your pet has received in the past, indicating the approximate time period when they were fed.  An example is given in italics. A detailed diet history of both commercial and homemade foods is particularly important if requesting novel protein diets.\n15. Please indicate whether your pet has experienced any of the following:\n(\tRecent involuntary or unintended weight change:\n( weight gain  OR  ( weight loss \tHow much? _____________kg or lb.\nOver what time period? ___________________\n(\tVomiting:\t________ times/day __________ times/week.\tOver what time period? ____________\n(\tDiarrhea:\t________ times/day __________ times/week.\tOver what time period? ____________\n16. Have you observed changes in any of the following:\n(\tUrination   OR  (\tDrinking \tWhat was the specific change?\nSince when?\nPage 3 of 4\n(\tDefecation\t What was the specific change?\nSince when?\n(\tAppetite\tWhat was the specific change?\nSince when?\n17. Does your pet have?  ( allergies  OR  difficulty  ( chewing  ( swallowing\nIf so, please describe:\n18. Pet dietary preferences and restrictions: (What ingredients will/can your pet eat?)\nPlease fill out this section if a home-cooked diet formulation is being requested or may be needed. If diet formulation is needed due to an adverse reaction to food(s), please provide us with some options of protein and carbohydrate sour","cbCaigPTKnLECZKH","https://ap.wps.com/l/cbCaigPTKnLECZKH","docx",745673,"English","# Pet information and living conditions\n## Feeding routines and potential food exposures\n## Medical history and current medications\n# Diet history and recent changes\n## Current diets and supplements\n## Previous diets and supplements\n# Symptoms and observed changes\n## Weight, vomiting, diarrhea\n## Urination, drinking, defecation, appetite\n# Allergies, restrictions, and follow-up consent\n## Allergies or chewing/swallowing difficulty\n## Dietary preferences and restrictions\n## Contact after starting the new diet","[{\"question\":\"What information does the questionnaire collect about my dog’s daily feeding routine?\",\"answer\":\"\"},{\"question\":\"How does the form request medication and supplement details?\",\"answer\":\"\"},{\"question\":\"What dietary changes, symptoms, and allergy-related information are covered?\",\"answer\":\"\"}]","DietHxHamper - Pet Diet History Questionnaire | DOCX"]