Senior Pet Wellness Questionnaire

Complete the questionnaire prior to your appointment so our team can learn more about your pet’s current health status and needs.

Your Name

Pet's Name

Mobile Number

Address

Does your pet still enjoy exercise?

More so than previously Less so than previously Same amount as previously

Does your pet have trouble climbing stairs, jumping into the car or onto furniture?

Yes No

Does your pet ever cough?

Yes No

Does your pet's breath smell?

Yes No

Does your pet seem listless or have less interest in food?

Yes No

What food does your pet currently eat?

How much does your pet eat in one day?

Do you think your pet has lost weight recently?

Yes No

Is your pet drinking more than usual?

Yes No

Have you noticed any lumps or bumps on your pet?

Yes No

Is your pet scratching or itching itself more than usual?

Yes No

Has your pet ever had a funny turn or collapsed?

Yes No

Have you noticed any changes to your pets faeces or urine (such as; consistency, frequency, presence of blood or need to strain)?

Yes No

Has your pet had any vomiting or diarrhoea recently?

Yes No

Has your pet started to urinate or defaecate in the house?

Yes No

Has your pet developed a decreased tolerance to being left alone?

Yes No

Is your pet still interacting with you and your family in the same way?

Yes No

Any other additional comments to add? Please write them here: