Name: Macungie Animal Hospital
Address: 161 East Main St, Macungie, PA, 18062, US
Telephone: (610) 421-8381
Price range: $$

Tender Transitions Questionnaire

Your Name*
First Last
Phone*
Email
Pet's Name (first,last)*
What concerns do you have for your pet as he/she ages or in general?*
What expectations do you have for this program?*
What current medications/supplements is your pet on and when do you give them?*
What is your pet’s daily routine?*
What is your pet’s environment like at home?*
Pictures of your pet's environment (if possible)
Drop files here or
What type of floors are in your household?*
Sleeping Habits
Does your pet sleep peacefully through the night?*
- Yes
- No
Where does your pet normally sleep? Has this changed recently?*
Has your pet experienced any:*
- Increase in urination
- Urinary accidents
- Urine incontinence (lack of voluntary control over urine)
- Fecal incontinence (lack of voluntary control over feces)
- None of the above
Have you noticed any:*
- Changes in hearing
- Change in their bark/meow
- Vocalizing frequently
- Coughing or coughing more
- Bad breath
- Frequent panting
- Decreased vision
- None of the above
Skin
Have you noticed any:*
- Itching
- Bad odor
- Licking/chewing body
- Decreased grooming habits (cats)
- Flaky skin
- Oily skin
- Unkempt or matted hair coat
- None of the above
Does your pet seek out areas that are:*
- Hot
- Cold
- Soft
- Hard
- Sunny
Mentation
Does your pet do any of the following?*
- Pace during the day or night
- Stare off into space
- Behavior Changes
- Interacting less with family
- Hiding more
- Disoriented or distant during the day
- Finding them stuck in odd locations
- Other
- None of the above
How long is your pet left by him/herself during the day?*
What are your pets favorite activities?*
What are your pets dislikes?*
Mobility
Check all that apply to your pet*
- Needs assistance getting up
- Needs assistance walking
- Dragging feet/toes
- Changes in gait/walk
- Difficulty jumping
- Thinking/hesitating before jumping
- Less time on higher surfaces than previously (cat)
- Must use stairs at home (inside or outside)
- Needs assistance climbing stairs
- None of the above
What is the best time of day to contact you between 8am to 7pm?*
What method of communication do you prefer? (call, text, or email)*
Is there anything else you would like us to know about you or your pet?

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Contact

161 East Main St.,
Macungie, PA 18062

(610) 421-8381
portal@macungieanimalhospital.com

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Hours

Monday & Thursday:
8:00 AM – 7:00 PM
Tuesday, Wednesday, Friday:
8:00 AM – 6:00 PM
Saturday:
8:00 AM – 2:00 PM

Tender Transitions Questionnaire

Sleeping Habits

Skin

Mentation