Senior Pet Questionnaire

Do you have a cat or small dog who is 9 or older, or a large dog above the age of 6? Then you are the proud owner of a senior pet that needs a little extra love and care. We would love to know a little bit more about your senior pet to make sure we are giving them the best care. Please take some time to answer our questionnaire.

Your Full Name *

Phone Number *

Email Address *

Pet's Name *

Activity Levels

Have they lost interest in activities (eg: walks, playing with a favourite toy, etc.)? *

Do they have difficulty when trying to stand or get up from a lying position? *

Are they no longer able to go up/down stairs, or do they avoid certain areas of your home(certain types of flooring)? *

Do they avoid certain physical activities (such as walking on a certain leg/foot, or walking at all)? *

For cats, is your pet struggling to jump onto higher surfaces?

Do they need help to get around normally? *

Has their mobility changed in the last year? *

Sleeping Habits

How many hours of sleep does your pet average in a day? *

Do they sleep through the night? If not, what are they doing? *

Appetite

What diet is your pet on currently? How much of it do they eat in a day? *

Has the amount of food they consume gone down/up? *

Have you noticed a significant change in their weight? *

Are they not eating the things they used to love? *

Do they turn down offers of treats or cookies? *

Has the amount of water they’re drinking gone down or up significantly? *

Attitude

Has there been changes to how they interact with some family members? *

Does your pet seem less interested in giving you affection? *

Has their interest or willingness to come to you and engage with you become reduced? *

Are they hiding more and seeking to be alone more than they have in the past? *

Does it seem like they’re not responding to your affection as much as usual? *

Does your pet pace during the day, stare off into space or act disoriented? *

Does your pet have an increase in anxiety or aggression? *

Other Information

Are there any other pets in the house (How old/what kind/how many)? *

Please list any medications your pet is on and how frequently they are receiving them along with the last time they were given:

Are there any specific concerns you wanted to have addressed?

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

Senior Pet Questionnaire

Activity Levels

Sleeping Habits

Appetite

Attitude

Other Questions

Other Information

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