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Canine Senior Questionnaire



    NoYes

    Symptom Checklist for Senior Dogs

    Please CHECK all that apply to your dog

    My dog is just not acting like himselfMy dog is not seeking much attention and interacts lessMy dog seems confused or disorientedMy dog has been barking or howling excessively for no apparent reasonMy dog's sleeping patterns have changedMy dog has had tremors or episodes of shakingMy dog has displayed circling, head tilts or repetitive movements

    My dog has been coughingMy dog seems to be panting moreMy dog tires more rapidly or seems short of breath

    I have noticed a change in my dog's activity levelMy dog lags behind on walksMy dog has difficulty climbing stairs and jumping or getting up from laying downMy dog limps, especially after exerciseMy dog shows signs of pain

    My dog has bad breath and/or red or swollen gums.My dog has difficulty chewingMy dog has gained or lost weightMy dog is drinking more water than usualMy dog's house-training habits have changed (increased frequency, diarrhea, constipation, or straining)My dog vomits more than in the pastMy dog seems to have trouble seeingMy dog seems to have trouble hearingMy dog is bumping into things

    My dog scratches, licks, and/or chews excessivelyMy dog has changes in hair coat, skin or new lumps and bumpsMy dog's skin has an odor