Senior Care Checklist

This checklist can help you identify early stages of brain aging in older patients -and help prevent aging-associated problems.

As a pet ages, there are often changes in behavior or signs of deteriorating alertness and health.

Answering some simple questions can help identify problems and focus on the right solution early. This checklist is an excellent tool to help assess an aging pet's current status. It can reveal areas of potential problems that may need immediate medical attention and/or ongoing follow-up.

Use this checklist during rechecks to monitor changes and track progress of treatment. Senior pet screening is recommended for all patients 7 years of age and older.
Owner Name
First Last
Pet Name
Breed
Age in years
Weight
Sex
Is the pet currently taking any medications (e.g., heartworm preventative, flea treatment), supplements or special diets?
Please list all medications below
Have you noticed any changes in your older pet's habits or behavior?
Answer questions in the chart below about changes in the pet's behavior. Check the box that applies.
Does your pet seek attention less often?
Does your pet seem listless or less responsive to interaction?
Does your pet appear lost or confused in the house or yard?
Does your pet fail to recognize familiar people or other pets?
Does your pet fail to recognize familiar people or other pets?
Sleep more during the day or less during the night?
Wander, pace or exhibit signs of restlessness?
Urinate indoors?
Have accidents indoors right after being outside?
Is your pet currently taking any medications for treatment of cognitive dysfunction syndrome (CDS)?
Please list medications below
Have any medications for treatment of cognitive dysfunction syndrome (CDS) been prescribed for your pet in the past?
Please list medications
Have you noticed any changes in your pet's health?
Answer questions in the chart below about changes in the pet's health. Check the box that applies.
More frequent urination?
Signs of increased stiffness, limping, difficulty climbing stairs?
Noticeable weight gain or loss?
Changes in coat or skin?
New lumps or bumps, or changes in appearance of existing ones?
Bad breath or red and swollen gums?
An increase in appetite?
A decrease in appetite?
Vomiting?
Diarrhea or stool with mucus or blood?
Constipation or difficulty defecating?
An obvious increase in thirst and excessive water drinking?
Coughing, weakness after exercise, prolonged panting?
Muscle tremors or shaking?
Weak, uncoordinated movements?
Signs of vision loss (e.g., bumping into objects, fear of moving forward)?
Signs of hearing loss (e.g., lack of response when called or at loud noises)?
Do you have any worries and/or concerns about your pet (not included in the charts above)? If so, please describe:

Senior Care Checklist

Have you noticed any changes in your older pet's habits or behavior?

Have you noticed any changes in your pet's health?