Pet nutrition awareness has risen enormously, with an increasing interest in homemade diets aimed at controlling food composition. Literature in this field is scarce, especially regarding the homemade diet’s long-term effects on pathological conditions. This prospective study encompassed 167 healthy and sick dogs subjected to a customized dietary plan based on homemade food. After an initial visit, dog owners provided questionnaires with follow-up data on their perceptions of physical signs changes or symptom modifications. 104 (62%) subjects maintained the homemade diet, while 63 reverted to their previous diet. The median follow-up was 14 months. Out of 31 healthy dogs that continued the nutritional plan, 70% exhibited improvements in their coat condition and 47% a decrease in evacuation frequency. Regarding weight loss goals, 67% of dogs achieved their target. The 67 pathological dogs that completed the follow-up were primarily affected by gastrointestinal and dermatological disorders. Dogs with chronic enteropathy improved their symptoms in 95% of the cases, subjects with dermatological pathologies in 83%, and patients presenting both disorders in 100%. These clinical results are promising. Personalized and well-balanced homemade diets noticeably enhanced the overall pet’s health, with almost a complete remission of symptoms in pathological dogs.