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I finally passed all the levels but still need to get Expert on many of them. On level 51 I only gave extras at the beginning of the game when there weren't customers lined up outside and when they asked for them. As someone else said, I gave out rainbow birds to all who had a question mark and rainbow fish for fish with question marks. I would also go ahead and pick up 2 dogs when the "big" ladies came in since they usually ask for those. In level 52 I keps 1 dog on the vet table so it would be ready when someone wanted a +dog.
Tried to chain as much as possible and always clicked on the "pet" house as soon as that came available.