Osteoarthritis & Lameness Questionnaire

We are looking forward to seeing you and your pet. In order to help us understand your pet’s Osteoarthritis/Lameness issues, please complete this questionnaire prior to your appointment. Your answers will help us give your pet the best care possible.

Please note: any fields with * are required.

Today's Date *

Owner's Details

Owner's Name *

First

Last

Email *

Owner's Phone Number *

Pet's Details

Pet's Name *

Species of Pet *

Breed of Pet *

Pet's Age *

Sex *

Male
Female

Desexed? *

Background

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

Up to 6 months
6–12 months
12–24 months
24–36 months
more than 36 months

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

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? *

0–0.6 miles
0.6–1.2 miles
1.2–1.9 miles
1.9–2.5 miles
more than 2.5 miles

In the last week, on average, how many walks has your dog had each day? *

0
1
2
3
4
More than 4

What type of exercise is this? *

Always on leash
Mostly on leash
Mostly off leash
Always off leash
Working

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

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Check all that apply.

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

Who limits the extent to which your dog exercises? *

You
Your dog

Mobility

How is your dog’s mobility in general? *

Very good
Good
Fair
Poor
Very poor

How disabled is your dog by his/her lameness? *

Not at all disabled
Slightly disabled
Moderately disabled
Severely disabled
Extremely disabled

How active is your dog? *

Not at all active
Slightly active
Moderately active
Severely active
Extremely active

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

No effect
Mild effect
Moderate effect
Severely effect
Extremely effect

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

No stiffness
Mild stiffness
Moderate stiffness
Severely stiffness
Extremely stiffness

At exercise, how active is your dog? *

Extremely active
Very active
Fairly active
Not very active
Not at all active

How interested is your dog in exercising? *

Extremely interested
Very interested
Fairly interested
Not very interested
Not at all interested

How would you rate your dog’s ability to exercise? *

Very good
Good
Fair
Poor
Very poor

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

No effect
Mild effect
Moderate effect
Severe effect
Extreme effect

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

Never
Hardly ever
Occasionally
Frequently
Very frequently

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

No effect
Mild effect
Moderate effect
Severe effect
Extreme effect

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

No stiffness
Mild stiffness
Moderate stiffness
Severe stiffness
Extreme stiffness

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

No effect
Mild effect
Moderate effect
Severe effect
Extreme effect

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Address

66 Old Hume Hwy
Braemar NSW 2575, Australia

Contact Us

Call: (02) 4872 1144
Email: info@highlandsveterinaryhospital.com.au

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Hours

Mon – Fri: 8:15 am to 5:00 pm
Sat: 8:15 am to 12:00 pm
Sun: Closed

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Send us a message!

Have a question? We’re here to help. Please complete the form below and we’ll get back to you as quickly as possible. If you need immediate assistance during business hours, please call us directly at (02) 4872 1144.

Name *

First

Last

Email *

Phone

How can we help you? *

Name