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  Email : \u001f\u001f\t\t\t                           Date:\nWe require the following to proceed with the consult: (Please check)\nNutrition Consult Request Form – Completed by DVM \t\tIncluded  (\nDiet History Form – Completed by owner\t\t\tIncluded  (\nComplete Blood Count\t\t\t\t\tIncluded  (\nSerum Chemistry Panel (inc. T4 if indicated)\t\t\tIncluded  (\nUrinalysis\t\t\t\t\tIncluded  (\nOther relevant medical records as necessary (UPC & BP for pets with CKD, biopsy and imaging results for pets with gastrointestinal or hepatic disease, etc.)\tIncluded  (\n**********Please ensure all labwork is current (within the last 6 months)**********\nReason for request: (Please check one or more)\n( Balance current home-cooked diet (Please attach a list of ingredients with amounts fed daily)\n( Formulate home-cooked diet, because no commercial diet available to meet pet’s needs\n( Pet finds commercial diets unpalatable\n( Other, please specify:\nPlease note if the request is urgent (additional fee will apply)\nMay we contact the owner directly with questions if needed?  ( Yes ( No\nOwner name:\t\t\t\t   Pet name:\nSpecies: \t\tAge: \t\tBreed:\t\t\t       Sex:   M,     MC,    F,    FS  (circle one)\nMuscle Condition Score:  Normal,  Mild loss,  Moderate loss,  Severe loss (circle one)\nBody Condition Score (9 point scale): (Dogs: 4 to 5 is ideal; Cats: 5 is ideal)\nBody weight:  Current:\t\t\tIdeal: \t\t\t\t(Please indicate kg or lb)\nCurrent medical problems: (Attach additional sheet if necessary)\nDoes the pet have a good appetite?     Typically: ( Yes ( No        Currently: ( Yes ( No\nHas the pet been weight-stable?       Historically: ( Yes ( No        Currently: ( Yes ( No\nPrevious medical history: (Please include dates)\nOther considerations: (Attach additional sheet if necessary)\nCurrent medications: (Attach additional sheet if necessary)\nPlease read the FAQ and review the recipe template on our website prior to submitting this consult request.\nThank you for your request. We will contact you with follow-up questions as needed.\nCustomized home-cooked recipe formulation is $528, which is charged when the request is submitted ($260 for the Nutritional Assessment (nonrefundable) and $268 for the diet formulation). This includes up to 30 minutes of follow up.\nAdditional follow-up is $124 per 30 minutes; this includes review of medical records as well as communications.\nIf the initial diet formulation is not tolerated or palatable, one recipe reformulation can be provided at no charge if requested within 6 months of the initial formulation. Other diet reformulations and additional recipes are $336 each if requested within 6 months of the initial formulation. Calorie adjustments are always provided at no charge.\nPrices are current as of January 2026, but are subject to change. An invoice will be automatically emailed directly to your clinic by the VMTH Cashier’s Office. If your clinic wishes to opt out of paperless billing and receive a printed statement or invoice, please reach out to our billing team at \u0013 HYPERLINK \"mailto:vmcbilling@ucdavis.edu\" \\t \"_blank\" \u0014vmcbilling@ucdavis.edu\u0015. Please do not send payment prior to receiving the invoice.","cbCaishinVQ8iEp7","https://ap.wps.com/l/cbCaishinVQ8iEp7","docx",67942,"English","# Consultation request requirements\n## Required documents and current labwork\n## Reason for request and urgency\n# Client and pet information\n## Condition scores and medical background\n# Fees and billing notes","[{\"question\":\"申请营养咨询需要提交哪些资料？\",\"answer\":\"需勾选并提供：由DVM填写的申请表、由主人完成的饮食史表、CBC、血清生化（如适用含T4）、尿检，以及根据病情需要的其他医疗记录。\"},{\"question\":\"化验结果需要满足多长的时效要求？\",\"answer\":\"所有实验室检查需保持当前状态，需在过去6个月内完成。\"},{\"question\":\"如需追加随访或配方调整，费用如何计算？\",\"answer\":\"追加随访按每30分钟124美元计费，包含病历审核与沟通。若初次配方在6个月内不耐受或不易接受，可在无额外费用下提供一次复配；其他复配与额外食谱按每份336美元计费。\"},{\"question\":\"是否可以在需要时直接联系宠物主人？\",\"answer\":\"申请表中会询问是否允许直接联系；根据勾选结果提供后续提问与沟通方式。\"}]","Nutrition Consult Request Form - Veterinary Medical Teaching Hospital - 服务流程与费用说明 | DOCX",1788274480]