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Overall health
(Assess the general status of the patient from the owners perspective.)
Body condition
Seems to be gaining weight Seems to be losing weight Bones are more prominent No changes noted
Food intake
Describe type and amount, including treats and snacks:
Increased Since when? Decreased Since when? Will eat with encouragement or is finicky Not eating Unchanged
Veritas 2012
Oral health
Odor / bad breath Paws or rubs face Eating with head twisted Drops food whilst eating Avoids contact with face No problems noted
Water intake
Estimated intake in a 24 hour period:
Urination
Increased amount of urine voided Gets up in the night to urinate Urinates in the house if left for more than 4 hours Leaking urine whilst sleeping Wet spots noted on bed or furniture Urine marking in the house Increased efforts difficulty noted whilst urinating Increased posturing to urinate Change in the appearance or odor of urine No change in urinary frequency, volume or habits
Describe:
Defecation
Describe frequency and regularity of defecation:
Stool appearance is changed Mucus Blood Color has changed Describe: Stool is narrower Increased efforts to defecate Increased number of bowel movement Defecates in the house Fecal incontinence No change in stool appearance or habits
Veritas 2012
Vomiting
Occasional vomiting How often? Vomits >1 x week Nature of vomit Food Fluid Yellow Red or red flecks Black or coffee ground appearance None noted
Breathing
Coughing Labored breathing Abnormal breathing noise Increased panting Change in bark No problems noted How often? Describe: Describe:
Exercise
Reluctant to exercise or disinterested Since when? No change in ability to exercise Decreased ability to exercise Since when? Fatigues or tires quickly Seems painful when exercising or after exercise No change in exercise habits
Mobility
Needs assistance to get up on furniture or in to vehicle Seems reluctant to move All the time After exercise Following period of rest Favors a limb Which one(s): Gait seems uneven or has changed Gets around effectively; no help needed
Veritas 2012
Pain assessment
Stiffness noted Difficulty getting settling to rest Lies in strange positions Reluctant to lie down Reluctant to move Favoring a limb Change in gait noted No pain noted
Veritas 2012
Veritas 2012