‘Golden Oldies’ Health & Wellness Questionnaire for Dogs

To enable your nurse to prepare for your dogs visit to our Golden Oldies Health & Wellness clinic, it’s useful to complete and submit the questionnaire below.

Title*

Your Name*

Your Email*

Address line one*

Address line two

Town*

County*

Postcode*

Pet's name*

Age*

Breed*

Appetite and Dental Health
Is you dog:

Eating*

Are they taking longer to eat meals*?

Do they have bad breath?*

Can they still eat hard food?*

Are they drinking more?*

Joints and Mobility
Is you dog:

Exercising*

Have you noticed any problems with your pet*:

Walking?

Jumping?

Going up and down stairs?

Getting on/off furniture?

Rising in the morning/from a nap?

Toileting
Is your dog:

Urinating*:

Have you noticed any change in faeces?
Colour:*

Shape:*

Amount:*

Behaviour

Have you noticed any changes in your dog's behaviour?*

Does your pet ever seem vacant or forgetful?*