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Super senior assessment form
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Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Pet's name
(Required)
Do you have any concerns with your pet's health or wellbeing?
Are they currently taking any supplements or medications? Which ones?
Diet
What diet are you currently feeding your pet and have you noticed any changes over the last year in appetite?
Are they occasionally struggling to pick up the pieces/making more of a mess around their plate?
Are they eating more or less than a year ago?
Are they being fussy with foods?
Did you notice any bad breath?
Have you noticed a change in their weight?
Movement
Are they managing the stairs?
Are they jumping on furniture and moving around the house like they used to?
Are they enjoying walks or playing like they used to?
Are they sleeping more than they used to?
Did you notice any stiffness or lameness at all?
Do they take longer to get up after resting?
Behaviour
Have you noticed any changes in your pet's behaviour?
Was there a change in temperament toward you or other pets in the house or outside?
Do they no longer liking to be touched or picked up?
Are they easily startled?
Are they panting more than they used to? (Cats: Panting at all.)
Do they seem restless or anxious more than they used to?
Are they making sounds for no apparent reason, especially at night? Meowing or barking for no reason or at night.
Have you seen them bumping into objects or missing steps/jumps?
Do you notice them ignoring you or having difficulty hearing you?
Do they ever appear disorientated?
Medical changes
Have you seen any other medical changes?
Any lumps or bumps?
Any changes in their stools?
Any changes with urinating - more or in odd places (in the house).
Did you notice any vomiting? (Cats: Including hairballs.)
Did you notice any coughing or retching?
Any sneezing?
Any bald patches?
Any matted fur?
Any ingrown/overgrown nails?
Any itching, smelly or sore skin?
Do you have any other concerns you’d like to mention to us?
Thank you so much for your trust in our care – one of our nurses will get back with a report to you shortly and be able to give advice on what you and ourselves can do to help them age as well as they deserve!
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