Owner questionnaire for dogs with mobility problems

Thank you for agreeing to fill out this questionnaire.

Your participation will provide us with essential information about your pet, which is crucial in our efforts to address painful and debilitating conditions like arthritis. Please answer all questions to the best of your ability. If you have any questions about the questionnaire, please reach out to a healthcare team member at your veterinary clinic.

We appreciate your help.

Most of the questions are straightforward. Please ensure you select only one option per question unless instructed otherwise (such as in Question 4 under Lifestyle).

If you are unsure about how to answer any question, please reach out to a staff member for help.

CLIENT INFORMATION

Owner's Name

Phone

PET INFORMATION

Pet Name

Client Number

Date of Birth

Breed

Sex

Reference limb

LF RF LH RH

BACKGROUND

How long has your pet been suffering with his/her mobility problem?

Has your dog been diagnosed as suffering from any other problems in addition to his/ her orthopedic disease?

No Yes

Please list these if you can:

If you can, please list any medications that your pet is currently receiving, stating when he/she received the last dose of each:

LIFESTYLE

In the last week, on average, how far has your dog exercised each day?

Are there particular days of the week upon which your dog has significantly more exercise? (Check more than one box if necessary.)

On what sort of terrain does your dog most often exercise?

On level grass In woodland On street Over rough ground

At exercise, how is your dog handled?

Walk on leash Walk off leash Trot Run freely

Who limits the extent to which your dog exercises?

You Your dog

Mobility

Generaly

Score

How disabled is your dog by his/her lameness?

Score

What is the effect of cold, damp weather on your dog’s lameness?

Score

To what degree does your dog show stiffness in the affected leg after a ‘lie down’?

Score

At exercise

At exercise, how active is your dog?

Score

How interested is your dog in exercising?

Score

What overall effect does exercise have on your dog’s lameness?

Score

How often does your dog rest (stop/sit down) during exercise?

Score

What is the effect of cold, damp weather on your pet’s ability to exercise?

Score

To what degree does your dog show stiffness in the affected leg after a ‘lie down’ following exercise?

Score

What is the effect of your dog’s lameness on his/her ability to exercise?

Score

Total Score

Owner Questionnaire for Dogs with Mobility Problems

Answering the questions

CLIENT INFORMATION

PET INFORMATION

BACKGROUND

LIFESTYLE

Mobility

Generaly

At exercise

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Contact Information

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