First and Last Name *

Animals Name *

Phone Number *

Email *

What species are you feeding? *

Animals Age *

Animals Weight *

Animals Discipline (ie. Show, Pet Performance/ What type of performance) *

LiveStock Only: How long until show?

Are you currently feeding OptiWize? If so how much? If no, have your ordered yet? *

What do you hope Optiwize can do for your animal?

Does your animal have a veterinary diagnosis? If so what was the diagnosis? *

If not yet seen by a veterinarian, what is the issue/s you're facing? *

How long has it been going on? *

What treatment/ medications/ supplements have you tried? What are they currently on? *

Upload a video of your animal's movement 20-30 seconds each way (as shown above) ~ If having issues uploading videos, email to consult@optiwizehealth.com~ *****Should videos not load, please post a picture in this place and email videos to be able to submit the form****** *

Choose file or drag here

Supported format: mp4,m4v,mov

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Equine, Livestock: Upload hoof photos here (ground level on an even/ hard service) Pets: Upload full body photo ~ Required for money back guarantee. *

Choose file or drag here

Supported format: JPG, JPEG, PNG.

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Upload diagnostics (if you have the diagnostics please upload them)

Choose file or drag here

Supported format: JPG, JPEG, PNG, GIF, SVG.

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Your Claim has been submitted, please allow 24-48 hours for our team to review and contact you to further the process

If you are having trouble submitting the form please copy and paste the questions below and email the completed questions to consult@optiwizehealth.com

If you have not received your submission, please check your spam folder for an email from consult@optiwizehealth.com

Your Claim has been submitted, please allow 24-48 hours for our team to review and contact you to further the process

Consult Form