Pet’s name Owner’s name Email Weight gain or lossNoMildModerateSevereWhen did the problem begin?Appetite increase or decreaseNoMildModerateSevereWhen did the problem begin?Vomiting or diarrheaNoMildModerateSevereWhen did the problem begin?Increased drinking or urinationNoMildModerateSevereWhen did the problem begin?Coughing, weakness after exercise, or increased pantingNoMildModerateSevereWhen did the problem begin?Lumps or tumors, skin problemsNoMildModerateSevereWhen did the problem begin?Bad breath, sore gums, or difficulty chewingNoMildModerateSevereWhen did the problem begin?Decreased awareness or gets confuse or lostNoMildModerateSevereWhen did the problem begin?Marking or spraying, bowel movements, or incontinence in the houseNoMildModerateSevereWhen did the problem begin?Forgets previously known commandsNoMildModerateSevereWhen did the problem begin?Decreased affection of interaction with ownersNoMildModerateSevereWhen did the problem begin?Increased irritability or aggression - Decreased tolerance of handlingNoMildModerateSevereWhen did the problem begin?Increased fear or anxietyNoMildModerateSevereWhen did the problem begin?Decreased hearing or selective hearingNoMildModerateSevereWhen did the problem begin?Decreased tolerance of being left aloneNoMildModerateSevereWhen did the problem begin?Repetitive or compulsive behaviors: Pacing, Circling, Over-grooming, licking non-food items, Other:NoMildModerateSevereWhen did the problem begin?Decreased grooming or self careNoMildModerateSevereWhen did the problem begin?Uncoordinated or weakNoMildModerateSevereWhen did the problem begin?Muscle tremors or shakingNoMildModerateSevereWhen did the problem begin?Decreased activity or sleeping moreNoMildModerateSevereWhen did the problem begin?Difficulty climbing stairs or increased stiffnessNoMildModerateSevereWhen did the problem begin?Limping, lagging behind, or appearing stiff after exerciseNoMildModerateSevereWhen did the problem begin?Reluctant to climb stairs or jump upNoMildModerateSevereWhen did the problem begin?Slow to rise from resting positionNoMildModerateSevereWhen did the problem begin?Waking owners at nightNoMildModerateSevereWhen did the problem begin?Enter the code below: