Survey – Nutriment Survey

Tel: (01276) 63554

1 Lets get started

2 Health Conditions

3 Health Conditions

4

Firstly tell us a little bit about your dog
My Dog's name is*
and their age is
year(s) old
- Tick if age is approximate
And what breed is your dog?*
What type of diet is your dog currently being fed?*
- Raw
- Dry
- Wet
- Combination
- Other (please specify)
Other (please specify)*

This question relates to your dog's previous health conditions.

Has your dog previously been affected by any of the following conditions.
Please tick all that apply.
EYES*
- Watery
- Tear Stained
- Infected
- Itchy
- None of the above
SKIN*
- Hotspots
- Hives
- Flaky Skin/Dandruff
- Yeasty Skin
- Itchy Skin
- Fur Loss
- None of the above
STOMACH*
- Diarrhoea
- Wind
- Noisy/Gurgling Stomach
- Vomiting
- Constipation
- None of the above
GENERAL*
- Itchy Feet
- Smelly Ears
- Anal Gland Issues
- Other (please specify)
- None of the above
Other (please specify)*

This question relates to your dog's current health conditions.

Is your dog currently affected by any of the following conditions.
Please tick all that apply.
EYES*
- Watery
- Tear Stained
- Infected
- Itchy
- None of the above
SKIN*
- Hotspots
- Hives
- Flaky Skin/Dandruff
- Yeasty Skin
- Itchy Skin
- Fur Loss
- None of the above
STOMACH*
- Diarrhoea
- Wind
- Noisy/Gurgling Stomach
- Vomiting
- Constipation
- None of the above
GENERAL*
- Itchy Feet
- Smelly Ears
- Anal Gland Issues
- Other (please specify)
- None of the above
Other (please specify)*

The cause of the conditions

Do you know the cause of the conditions that your dog is currently affected by, or what caused these conditions in the past.
Please tick all that apply.
*
- Environment
- Diet
- Genetic Predisposition
- Unknown
- Other (please specify)
Other (please specify)*
If the condition(s) or health issue(s) is/are no longer present, what do you think was effective in helping treat the condition?
Please rate all factors that you believe helped your dog’s health improve and how effective each was on a scale of 1-10 (1 being not effective and 10 being very effective)
Vet prescribed medication
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Homeopathic or Holistic remedy
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
A change in diet
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Other (please specify)
If a change in diet helped to improve your dog's health condition, what did you feed them when their health condition first appeared?*
- Raw
- Dry
- Wet
- Combination
- Other (please specify)
Other (please specify)
And what did you feed your dog that you felt helped improve their health condition?*
- Raw
- Dry
- Wet
- Combination
- Other (please specify)
Other (please specify)
How quickly did you see an improvement?*
- Less than 2 weeks
- 1 month
- 1 - 3 months
- 3 - 6 months
- 6 months - 1 year
- Over 1 year

© Nutriment Survey 2019

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