At night, is your dog awake and seem restless or pace?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Has your dog become more vocal at night?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Does your dog defecate or urinate inside or doesn’t properly signal to go outside?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Does your dog have a decreased interest in normal activities including greeting you or showing affection?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Does your pet show anxiety or fear when entering a new environment?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Does your pet become anxious when you leave it alone?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Has your dog become more irritable/fearful/aggressive with visitors, family or other animals during social interactions?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Have you noticed that your dog gets distracted more easily?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Does your pet display a lack of interest in playing with toys, family members, or other pets?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Do you find your pet aimlessly pacing or wandering?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Has your pet become more reactive or fearful to visual or audio signals?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Has your dog become less responsive to its name and basic commands?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Does your pet exhibit repetitive behaviors, e.g., circling, getting “stuck”, chewing, licking, star gazing?
(Score as 0=none, 1=mild, 2=moderate, 3=severe)
Gender
Is your dog neutered/spayed/castrated?
Regarding your pet's weight, which of the following is true?
Daily Exercise/Activity
How would you describe your pet's health given it's age?
