Senior care health checklist

Although you rely on us to be the “experts”, you are the one who cares for your pet – day in and day out – and, therefore, you are more likely to notice subtle changes in your pet’s behavior or physical abilities. Help us make the most of your “Golden Paws” Senior Care visit and take a few moments to complete this checklist. What may look like normal signs of aging could actually be early signs of a manageable health condition.

Appointment date:

Your name:

Email:

Your pet's name:

Your pet's breed:

Your pet's sex:

Your pet's birthdate:

List any medications that your pet is currently taking (including flea and heartworm preventative).

Describe your pet’s diet. Please include the brand name, any treats/table scraps, amount of food given, and how frequently your pet is fed.

Please list any other comments/questions that you may have.

Disorientation

Please check any that apply:

Please add information for your choices above:

Interaction with family

Please check any that apply:

Please add information for your choices above:

Sleep and activity

Please check any that apply:

Please add information for your choices above:

House training

Please check any that apply:

Please add information for your choices above:

Physical changes

Please add information for your choices above:

Additional comments: