Pet's Name* Your Name* First Last Email* Phone* Please tell us about your pet’s diet.*Please tell us about any treats, dental chews, and human food your pet receives*If your pet’s appetite has changed or if his/her eating habits have changed, please describe here.*Does your pet readily eat his/her food? If not, do you offer treats/human food to entice your pet to eat? Please describe here.*Please list ALL medications your pet is on.*Does your pet have difficulty chewing or swallowing? Please describe here.*Has your pet had any weight fluctuations? Yes No Has it become a challenge to maintain your pet’s weight? Yes No Does your pet tolerate exercise and play like before?* Yes No Does your pet seem to be slow or painful when rising?* Yes No Does your pet seem more sensitive to your grooming or touching over the lower back/hips?* Yes No Does your pet seem more sensitive to your grooming or touching over the lower back/hips?* Yes No Does your pet wander aimlessly and/or seem disoriented?* Yes No Does your pet seem increasingly anxious, fearful, or irritable?* Yes No Has your pet exhibited any unusual vocalizations?* Yes No Does your pet seem to act “old”?* Yes No Does your pet seem to enjoy life as much as before?* Yes No When was your pet’s last visit to a veterinarian?* Has your pet had any diagnostic done in the last year?* Yes No If yes, where was it done at? Can we contact your pervious veterinary office for your pet’s history?* Yes No If your pet has had any behavior changes since his/her last visit, please describe here.If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.CommentsThis field is for validation purposes and should be left unchanged.