07.17 22:11
Senior Dog Check list 
Senior Dog Pain Assessment Checklist
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Use this checklist to monitor and track potential pain symptoms in your senior dog.
Print and take this with you to your next veterinary visit.

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Dog Name: __________________________
Date: ______________________________

1. Mobility
   [ ] Limping or stiffness
   [ ] Trouble getting up or lying down
   [ ] Reluctance to walk or exercise
   Notes: ___________________________

2. Vocalizations
   [ ] Whimpering or whining
   [ ] Yelping when touched
   [ ] Barking more than usual
   Notes: ___________________________

3. Behavior Changes
   [ ] Withdrawal or hiding
   [ ] Aggression or irritability
   [ ] Less interaction or play
   Notes: ___________________________

4. Eating & Drinking
   [ ] Loss of appetite
   [ ] Difficulty chewing
   [ ] Dropping food or avoiding meals
   Notes: ___________________________

5. Sleeping Patterns
   [ ] Restlessness or pacing
   [ ] Waking during the night
   [ ] Difficulty finding a comfortable position
   Notes: ___________________________

6. Body Posture & Appearance
   [ ] Hunched back or stiff gait
   [ ] Trembling or shaking
   [ ] Excessive licking of one area
   Notes: ___________________________

Severity Rating (circle one for each symptom):
None – Mild – Moderate – Severe – Emergency

Veterinarian Notes:
____________________________________
____________________________________

Reminder:
This checklist is not a substitute for veterinary care.
If symptoms worsen or persist, consult your vet immediately.

Provided by: SeniorPawsGuide.com