Feed This, Inc!
Questionnaire

We process questionnaires on weekly basis. You should receive a phone call or email within a week.

About You
Human Name:
Address:
City:
County:
State:
ZIP Code:
Delivery instructions such as gate codes or special drop off locations.
Email:
Day phone:
Home
Cell
Work
Other
Night phone:
Home
Cell
Work
Other
Fax:
What is most important to you? Cost
Cost & Convenience
Convenience
Number of pets you would like to put on the Feed This Diet:

(We provide a multi-pet discount.)

How did you hear of us?
Making the decision I am ready to start. I have provided my credit card and expiration date below and here is my order. I will be notified with a confirmation that the order has been processed.

Keeping in mind freezer space:

Send what you recommend for 2 weeks
Send what you recommend for 4 weeks
Send what you recommend for 8 weeks

Or:

Send me a total of lbs.
Please send me an estimate

I am on the fence. I would like a consultation. I understand that consultations are $1.00 per minute in 15 minute increments with a 30 minute minimum. I have provided my credit card & expiration date below and here are the times I am available. Please let me know when we can have our consultation. My credit card will be charged only after my consultation has been scheduled.
Availability:
I really need more general information on the raw diet. I have looked over your web site and I still have questions but I do not want a consultation.
Natural Nutrition for Dogs & Cats ($9.95)
Beyond Words: Talking with Animals & Nature ($14.95)
Ask Your Animal ($14.95)
Natural Nutrition for Cats ($9.95)
Learning Their Language: Intuitive Communication with Animals & Nature ($14.95)
Book orders add $5.50 for shipping and handling. Local taxes may apply.
I have filled out the questionnaire and I need a quote. After I get my quote, I will refer to one of the previous 3 choices.
Send me a quote for 1 week worth of food
Send me a quote for 2 weeks' worth of food
Send me a quote for 4 weeks' worth of food
Credit card information (optional)
Credit card type
Credit card number
Expiration date

About Your Pets
Pet name:
Date of birth:
Cat
Dog
Male
Female
Breed:
Altered? Yes
No
Unknown
Current weight:
Optimum weight:
Daily activities:
Will this pet be fasting one day a week? (Fasting is recommended but not required. Never fast a pet younger than a year of age) Yes
No
Undecided
Current diet:
How long?
Amount per day:
Feedings per day:
Has your pet been finicky in the past?
Preferred foods:
Foods to avoid:
Health and/or behavior issues:

Pet #2
Pet name:
Date of birth:
Cat
Dog
Male
Female
Breed:
Altered? Yes
No
Unknown
Current weight:
Optimum weight:
Daily activities:
Will this pet be fasting one day a week?

(Fasting is recommended but not required. Never fast a pet younger than a year of age) 		Yes
No
Current diet:
How long?
Amount per day:
Feedings per day:
Has your pet been finicky in the past?
Preferred foods:
Foods to avoid:
Health and/or behavior issues:

Pet #3
Pet name:
Date of birth:
Cat
Dog
Male
Female
Breed:
Altered? Yes
No
Unknown
Current weight:
Optimum weight:
Daily activities:
Will this pet be fasting one day a week?

(Fasting is recommended but not required. Never fast a pet younger than a year of age) 		Yes
No
Current diet:
How long?
Amount per day:
Feedings per day:
Has your pet been finicky in the past?
Preferred foods:
Foods to avoid:
Health and/or behavior issues:

Pet #4
Pet name:
Date of birth:
Cat
Dog
Male
Female
Breed:
Altered? Yes
No
Unknown
Current weight:
Optimum weight:
Daily activities:
Will this pet be fasting one day a week?

(Fasting is recommended but not required. Never fast a pet younger than a year of age) 		Yes
No
Current diet:
How long?
Amount per day:
Feedings per day:
Has your pet been finicky in the past?
Preferred foods:
Foods to avoid:
Health and/or behavior issues:

Pet #5
Pet name:
Date of birth:
Cat
Dog
Male
Female
Breed:
Altered? Yes
No
Unknown
Current weight:
Optimum weight:
Daily activities:
Will this pet be fasting one day a week?

(Fasting is recommended but not required. Never fast a pet younger than a year of age) 		Yes
No
Current diet:
How long?
Amount per day:
Feedings per day:
Has your pet been finicky in the past?
Preferred foods:
Foods to avoid:
Health and/or behavior issues:

Please contact us directly to provide us details about the additional pets that you want to sign up for the Feed This! service.

Animal Professionals You & Your Pets Work With
Current veterinarian:
Practitioner (chiropractic, acupuncture):
Trainer:
Are your service providers familiar with the raw diet?
Did a service provider recommend the raw diet?
What prompted you to choose the Feed This raw diet?
Additional notes about making the decision
Anything else?

When You Have Decided to Order

Feed This, Inc! has a one-time start up fee of $35.00. This includes initial consultation; treats, coupons, literature, silver cooler, ice packs, and other goodies.

Feed This, Inc!     PO Box 687, Forestville CA 95436     Phone: 707-823-7001     Fax: 707-823-7002     http://www.feedthis.com     Email: info@feedthis.com