Osteoarthritis & Lameness Questionnaire

Today's Date:

Owner's Details

Email:

Phone:

Pet's Details

Pet's Name:

Species of Pet:

Breed of Pet:

Pet's Age:

Sex:

MaleFemale

Desexed?:

YesNo

Background

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

YesNo

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

Lifestyle

Are there particular days of the week upon which your dog has significantly more exercise?

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

On level grassIn woodlandOn streetOver rough ground

At exercise, how is your dog handled?:

Walk on leashWalk off leashTrot

Who limits the extent to which your dog exercises?:

YouYour Dog

Mobility

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

No stiffnessMild stiffnessModerate stiffnessSeverely stiffnessExtremely stiffness

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

No stiffnessMild stiffnessModerate stiffnessSevere stiffnessExtreme stiffness

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