A little care. A stronger connection.

Every pet has a story.
Let’s start with yours.

Tell Marie about your companion’s everyday life, nourishment, and health history so your wellness conversation begins with the whole pet.

About 5–10 minutesSaved for Marie’s reviewNo account needed

Your connection

How Marie can reach you.

Owner’s name *

Email address *

Phone number

Meet your pet

A few basics about your companion.

Pet’s name *

Species *

Breed or mix *

Age (years or months) *

Weight *

Weight unit *

Sex / spay or neuter status

Skin, coat & everyday life

Tell us what you notice at home.

Coat and skin condition *

Main wellness concerns and when they started *

Activity, sleep, behavior, and home environment

Food & nourishment

The everyday menu matters. Include brands when known.

Current diet: brand, protein, and food type *

Amount, feeding schedule, and recent diet changes

Treats, table foods, supplements, oils, and other products

Appetite, water intake, stool, and digestive changes

Health & history

“None” or “unknown” is a helpful answer, too.

Known diagnoses, allergies, surgeries, or injuries

Current and past medications: names, doses if known, dates, and reactions *

Vaccine history: names, dates if known, and reactions *

Flea, tick, and heartworm prevention

Veterinarian / clinic and last visit

A thoughtful next step

Your answers and contact details will be stored online for Marie Jackson at Natural Pet Wellness Connection to review and follow up about your pet. They are not displayed to other pet owners. Answers are saved only when you submit.

I agree to have these details saved and used for my pet wellness inquiry.

Marie Jackson provides pet wellness education and is not a veterinarian. She does not diagnose, treat, or prescribe for medical conditions. This intake and any guidance provided do not replace veterinary care. This form is not monitored for emergencies; contact your veterinarian for medical or urgent concerns.

Fields marked * are required. Use “unknown” when needed.