Senior Dog Questionnaire Woody Dudley D.V.M Mitchell Hammock Pet Hospital 255 Alexandria Blvd. Oviedo, FL 32765 (407) 366-7323 • Fax (407) 542-8797 www.drwoody.net Name* Patient Name Last Name Date* MM slash DD slash YYYY SENIOR DOG QUESTIONNAIREPersonality: Tires easily Sleeping more than 13hr/day Depressed Not greeting you Not playing Not Wagging Tail Not enjoying treats Turning aggressive Snappy or grumpy Anxiety Pain and Discomfort: Declining activity level Trouble keeping balance Trouble getting up Restless Can’t get comfortable Whining Yelping Stiff legs while walking Stiffness getting up on a cold morning Tail continuously between legs Shaking continuously Heavy continuous panting Mouth Pain Dull, unkempt hair coat Problematic Symptoms: Vomiting Diarrhea Blood or mucous in the stool Loose stool Continuous discharge in the eyes Excessive loss of hair or excessive shedding Coughing Sneezing Lumps and bumps Loss of Bladder Control PHYSICAL CHANGES: Cloudy or bloodshot eyes Having vision trouble Bumping into things Disoriented or Confused Not coming when called Not responding to noise Appetite increase Appetite decrease Water consumption increase Water consumption decrease Labored breathing Urinating frequently Having accidents in the house Doesn’t recognize you Coments: