Aurora Hills Animal Hospital

14080 E. Mississippi Ave.
Aurora, CO 80012

(720)237-8744

aurorahillsanimalhospital.com

Aurora Hills Animal Hospital wants to know how is your senior pet doing?  Your pet isn't just "old" s/he may have treatable conditions!

Check off any signs that your pet is showing at home.

Senior Pet Survey

Client Name (required)
First Name (required)
Last Name (required)
Client Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Pet Information
Pet's Name (required)

Age *NA if unknown* (required)

Species (required)
Dog
Cat


Signs of senility (dementia):
* (required)
(Check all that apply)
Seems "hard of hearing"
Sleeping more during the day +/- wandering at night (interruption of day/night rhythm)
Vocalizing more
Getting "lost" in the house (gets stuck in corners or under tables too)
Loss of litter box/house training
NA
Signs of joint pain (arthritis):
* (required)
(Check all that apply)
Slower to rise, but "works out" the stiffness
Slower going up & down stairs
Doesn't jump up on furniture or countertops anymore or can't jump into the car
Gets tired more easily (on walks, during playtim, etc)
Legs tremble while standing
NA
Sings of dental disease:
* (required)
(Check all that apply)
Foul breath/odor (dogs & cats should have no more breath odor that a human)
Drooling
Eating more slowly
Refusion hard, kibbled, food
NA
Signs of kidney insufficiency:
* (required)
(Check all that apply)
Increased thirst & urination
Decreased appetite
Weight loss
NA
Signs of hyperthyroidism **CATS ONLY**
**CATS ONLY** (required)
(Check all that apply)
Increased thirst & urination
Increased appetite
Voice change, increased vocalization
Weight loss
Irritability
NA

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