Senior Health Checklist
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| No | Mild | Moderate | Severe | When did problem begin? |
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| Weight gain or loss | |||||
| Appetite increase or decrease | |||||
| Vomiting or diarrhea | |||||
| Constipation or difficult defecation | |||||
| Increased drinking or urination | |||||
| Coughing, weakness after exercise, or increased panting | |||||
| Lumps or Tumors, skin problems | |||||
| Bad breath, sore gums, or difficulty chewing | |||||
| Decreased awareness or gets confused or lost | |||||
| Marking or spraying, bowel movements, or incontinent in the house | |||||
| Forgets previously known commands | |||||
| Decreased affection or interaction with owners | |||||
| Increased irritability or aggression - Decreased tolerance of handling | |||||
| Increased fear or anxiety | |||||
| Decreased hearing or selective hearing | |||||
| Decreased tolerance of being left alone | |||||
| Repetitive or compulsive behaviors: Pacing__ Circling__ Over-grooming__ Licking non-food items__ Other__ |
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| Decreased grooming or self-care | |||||
| Uncoordinated or weak | |||||
| Muscle tremors or shaking | |||||
| Decreased activity or sleeping more | |||||
| Difficulty climbing stairs or increased stiffness | |||||
| Limping, lagging behind, or appearing stiff after exercise | |||||
| Reluctant to climb stairs or jump up | |||||
| Slow to rise from a resting position | |||||
| Excessive vocalization Day__ Night__ | |||||
| Waking owners at night |