Senior Wellness Checklist Form Skip to Main Content Skip to Footer

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Hours 12952 Olive Blvd
Creve Coeur, MO 63141

Senior Wellness Checklist Form

You know your pet best. In an effort to better serve the needs of you and your pet, please take a moment to consider the following possible changes in your aging pet.

Pet Name*

Have you noticed any of the following changes in your pet? If so, please tell us more information on the changes in the appropriate sections below.

Bad breath, sore gums, difficulty chewing

Increased drooling

Weight gain or loss

Appetite increase or decrease

Vomiting

Diarrhea

Constipation

Blood or mucus in stool

Blood in urine

Increase or decrease in amount or frequency of urination

Increase or decrease in amount or frequency of stool

Change in consistency of stool

Accidents in house

Increase or decrease in water intake

Sneezing, coughing

Panting or heavy breathing

Lethargy or seems tired

Any lumps or bumps

Muscle tremors, shaking

Changes in skin or coat

Stiffness, limping, difficulty getting up, weakness, incoordination

Drags foot or stumbles

Whining or meowing more

Confusion or disorientation

Fails to recognize you

Wanders or paces

Withdrawn or listless

Aggression

Changes in sleep pattern

Vision loss or eye issues

Hearing loss or ear issues

Decrease in grooming (cats)

Heritage Veterinary Hospital