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Senior Pet Questionnaire

Please complete this questionnaire and bring it with you to your appointment. It is designed to help you and your nurse provide the very best care for your pet.

Which practice would you like to register with?

Contact details

Pet details

Appearance and Body Condition

Do you think your pet’s body weight has changed
Have you noticed any of the following regarding your pet’s coat/skin? (tick all those that apply)






Is your pet still able to groom themself?
Have you noticed any lumps or bumps on your pet?
Have you noticed any of the following? (tick all those that apply)





Do you have any concerns regarding your pet’s vision or hearing?

Eating and Drinking

Has your pet's appetite
Does your pet have any problems eating?
Have you noticed that your pet suffers with any of the following, regularly? (tick all those that apply)
Has your pet's thirst


Sleep

Does your pet now sleep more during the day and sleep less at night?
Do they have a peaceful sleep at night?
If NO, do they get up during the night to (tick all those that apply)

Mobility

Does have any of these mobility issues?







What floor type(s) do you have at home? (tick all those that apply)
Has this changed in the past year?

Behaviour & Additional Info

Have you noticed your pet doing any of the following? (tick all those that apply)







Is your pet on any medication or supplements

Security Question