Max Pug

Dog Health Checklist

Dog 's Name



1. Has your dog’s weight changed unexpectedly recently?

  • My dog has lost interest in food and is losing weight
  • My dog is being fed the same amount but is losing weight
  • My dog is eating the same amount but is gaining weight
  • My dog is eating more and gaining weight
  • My dog’s weight has not changed recently

2. Have you noticed any recent changes in your dog’s water consumption?

  • My dog seems to be thirstier and drinks more water
  • My dog appears to drink less water than before
  • My dog drinks about the same amount of water as always

3. Have you noticed any of the following characteristics in your dog’s stool?

  • Nothing unusual
  • Fresh blood and/or mucus
  • Black, tarry color
  • Rice-like white specks on stool that sometimes move

4. Have you noticed any changes in your dog’s urination habits?

  • Nothing unusual
  • My dog urinates more frequently than before
  • My dog seems to strain to urinate
  • My dog urinates in inappropriate places

5. How would you describe the inside of your dog’s ears?

  • Normal (no discharge, skin smooth, mild pleasant odor)
  • Waxy (brown discharge from the ear)
  • Skin rough and dry in the ear
  • Skin moist and red with an unpleasant odor in the ear

6. Does your dog seem to be scratching excessively in any of the following areas?

  • Around the ears
  • All over the body
  • Around the anal area
  • My dog scratches only occasionally

7. How would you describe your dog’s skin?

  • Smooth, flesh-colored
  • Areas of red marks, bumps, or scales

8. Does your dog have any of the following breathing problems? (check all that apply)

  • A honking "cough"
  • Struggles to catch breath, especially after exercise
  • Wheezing
  • Bark has changed
  • Dog snores loudly
  • Panting
  • None of the above

9. How often do you take your dog to the veterinary clinic (not including emergencies)?

  • Twice a year
  • Annually
  • Every few years
  • Rarely or never

10. Is your dog on heartworm prevention?

  • Yes
  • No

11. When was the last time you took a stool sample to your veterinary clinic for examination?

  • Within the past year
  • More than a year ago

12. Has your dog received a dewormer in the last year?

  • Yes
  • No

13. Is your dog on a flea control treatment?

  • Yes
  • No

14. Is your dog on a tick control treatment?

  • Yes
  • No

15. How much time does your pet spend outside?

  • Rarely
  • For walks
  • 25%
  • 50%
  • 75%
  • 100%

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