Lakeside Veterinary Clinic Senior Pet Care Health Checklist

Date: ______________________________

Owner ______________________________________________

Pet Name: ___________________________________________

We have put together this checklist of health questions for your review prior to doctor visits. This information will be helpful in determining the best course of treatment for your senior pet. Please help us by indicating if your pet:

1. Shows any change in behavior since your last visit?

2. Limps or has difficulty getting up from a lying position?

3. Hesitates going up or down stairs, or getting on/off elevated surfaces?

4. Has an increase or decrease in weight?

5. Moans, growls, or whines when touched or bumped anywhere?

6. Is less active recently?

7. Any changes in water consumption or urine production?

8. Have urine or stool accidents in the house?

9. Has bad breath?

10. Has experienced any recent vomiting, diarrhea, or constipation?

11. Coughs, sneezes, or pants more than a little?

12. Licks or chews on any certain part of the body for more than a minute a day?

13. Has ever had a seizure?

14. Seems to be losing sight or hearing?

15. Has a recent skin or hair coat change?

16. Recently developed lumps or bumps anywhere on the body?

17. Seems confused or disoriented?

18. Doesn’t greet you with as much enthusiasm as usual?

19. Seems less interactive with household members in general?

20. Has experienced a change in sleeping pattern?

21. Starts yowling or barking for unusual or unknown reason?

22. Has shown aggression towards people or other animals?