Senior Pet Questionnaire

Your Full Name *

Phone Number *

Email Address *

Pet's Name *

Tell Us About Your Pet's Health

What is your pet’s current diet? (Brand/amount/dry or wet/ and do they receive any treats or people food?) *

How is your pet’s appetite and drinking amounts? *

Has your pet experienced any unexpected weight loss or gain? *

How is your pet’s urination frequency? (i.e. normal, increased or decreased) *

Is your pet having any accidents? If so, what is the frequency? *

Does your pet sleep peacefully through the night? *

How is your pet’s defecation (normal/soft/hard)? Any diarrhea of concern? *

Any vomiting of concern? *

Any coughing or sneezing of concern? *

Any new lumps or growths of concern? *

Any new itching/scratching or skin concerns? *

Any new limping or mobility issue/energy or attitude changes? *

Does your pet struggle or rise or sit? Have trouble doing stairs or jump up? *

Does your pet have any changes in their hearing or eyesight? *

Any plans of travel or camping in the near future (if so where)? *

Does your pet receive any dental homecare – please specify (teeth brushing, dental treats or food, etc) *

Is your pet on any medications or supplements? *

Any joint supplements or products for joint health? *

Cat Owners - Does your cat go outside?

Cat Owners - Does your cat still groom itself?

Does your pet go to dog parks/daycares/kennels/groomers? *

Do you have pet insurance? If so please specify the provider. *

Do you have any other concerns or notes for the doctor to know?

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *