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concordparkwayanimalhospital@gmail.com
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Senior Lifestyle Review Form

To help us more effectively plan your senior pet’s care, please complete this form providing us with more details on their lifestyle and environment.

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Senior Lifestyle Review Form

Helping your senior pet thrive is our priority. Complete the Senior Lifestyle Review Form to ensure we address your pet’s unique needs and support their health and well-being as they age gracefully. Please provide accurate and detailed information to help us deliver the best care possible.

You may use the PDF version by clicking the DOWNLOAD FORM button and then completing the printed form by hand. Please bring the completed PDF form with you for your pet’s first appointment.

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Have you noticed any behavior changes in your older pet recently? They could be signs of a medical, or behavior issue or, possibly, dementia. To help narrow the cause, please check all that apply.

Name *

Email *

Disorientation-awareness-spatial orientation

Pacing during the day
Seems confused or disoriented
Stares blankly at wall, the floor or into space
Has been meowing or whimpering for no apparent reason
Drops food and has a problem finding it
Goes to the hinge or wrong side of door
Has not been recognizing familiar people or familiar pets
Experienced any seizures

Altered social interactions

Showing increased attention-seeking or over-attachment to family members
Interacts less with the family or other pets

Sleep-wake cycles

Is experiencing instances of waking or being restless at night
Is sleeping noticeably more during the day
Sleeps almost around the clock

Housetraining, learning and memory

Has been soiling indoors: Urine stools
Is showing a decreased response to its name or learned command, tricks or work

Body Functions

Has difficulty chewing
Is showing a decreased response to its name or learned command, tricks or work
Has gained
lost weight
Change in how much they eat
Is drinking more water than usual
Is urinating more frequently
Leaks urine when asleep
Leaks urine when awake
Vomits more than occasionally
Having trouble seeing or hearing

Anxiety or response to stimuli

More fearful, anxious, or unsettled
Increased anxiety when separated from family
Increased fear in new places

Activity

Reduced physical activity: walking, running, swimming, or playing
Needs help walking, rising, etc

Shows signs of pain (check all that apply)

Hiding
Limping
Panting
Unusually quiet
Vocalizing

Skin and Coat

Nails longer than normal
Not grooming well
Scratches, licks, and chews excessively

Changes in haircoat, skin, or new lumps or bumps (check all that apply)

Flaky
Oily
Unkempt

Does your pet have a favorite game?

If yes, please explain

What foods and treats are you currently feeding your pet?

How Often?

Is your pet receiving any medications/supplements other than ones dispensed from this hospital?

If yes, Please explain

Do you need any refills?

Please note any question or topics you would like to discuss

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Make an Appointment

We proudly serve the pets of Concord, Kannapolis, Charlotte, Midland, Mt. Pleasant, Harrisburg, and the surrounding areas. We look forward to seeing you and your pet! Click the button below to book an appointment.

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Location

308 Concord Parkway N.
Concord, NC 28027

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Contact Information

Phone: (704) 786-1135
Email: concordparkwayanimalhospital@gmail.com

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Hours

Mon–Wed: 7:30 AM – 6:00 PM
Thurs: 7:30 AM – 7:00 PM
Fri: 7:30 AM – 6:00 PM

Have a Question?

We invite you to connect with us. Once you fill out the form, a member of our dedicated team at Concord Parkway Animal Hospital will reach out to you promptly.

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