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Golden Oldies Dog Form

‘Golden Oldies’ Health & Wellness Questionnaire for Dogs

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

Which practice would you like to register with?

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Appetite & Dental Health

Is your dog eating


Are they taking longer to eat meals?

Do they have bad breath?

Can they still eat hard food?

Is your pet drinking


Joints & Mobility

Is your dog exercising


Have you noticed any problems with your pet walking?

Have you noticed any problems with your pet jumping?

Have you noticed any problems with your pet going up and down stairs?

Have you noticed any problems with your pet getting on/off furniture?

Have you noticed any problems with your pet rising in the morning/from a nap?

Toileting

Have you noticed your dog urinating


Have you noticed any change in faeces colour?

Have you noticed any change in faeces shape?

Have you noticed any change in faeces amount?

Behaviour

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

Does your pet ever seem vacant or forgetful?

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