Mobility/Limping/Arthritis Form Name * First Name Last Name Pet's Name * Any difficulty getting up and down? * Yes No Is your pet walking stiffly? * Yes No Any lameness in one or more legs? * Yes No If yes, please describe Any reluctance to go up and/or down stairs? * Yes No Any reluctance to jump up or down? (onto/off furniture or into/out of a vehicle) * Yes No Any visibly stiff, swollen, or sore joints? * Yes No Any reluctance to be touched on some parts of the body? * Yes No Any loss of stamina? * Yes No Any unexpected aggression towards other dogs or towards humans? * Yes No Any excessive or elevated panting? * Yes No Any changes to your pets eating or drinking habits? * Yes No Any abnormal GI upset like vomiting or diarrhea? * Yes No Any allergy symptoms like coughing or sneezing? * Yes No Any new lumps/bumps? * Yes No If yes, please describe Any other questions or major issues you’d like the doctor to be aware of? What is your pet's current diet? * Please list all medication/supplements/herbals * Your form has been successfully submitted. Thank you!
