Quality of Life Questionnaire

Thank you for choosing HIGHlands Veterinary Hospital.

Please complete our Quality of Life Questionnaire before your first appointment.

Please Note: Any fields with * are required.

How Do I Know When It’s Time?

Assessing Quality of Life for Your Companion Animal and Making End-of-Life Decisions

Deciding to euthanise your pet may be one of the most difficult decisions you ever make. Often, well-loved pets are euthanised to minimize unnecessary suffering. The quality of animals’ lives is defined by their overall physical and mental well-being, not just one aspect of their lives. 

The questionnaire (below) assists in considering all aspects of your pet’s life when deciding on euthanasia. It is important to remember that all pets are different. What may be considered a poor quality of life for one may be different for another.

Higher numbers on this chart equal a better quality of life. This questionnaire may help you to better visualise the general well-being of your pet. In some cases, even one item rating severe on the scale (for example: pain) may indicate a poor quality of life, even if many of the other items are still rated mild or non-existent. 

Some items or symptoms on the list may be expected side effects of the treatments that your pet is undergoing. It is important to discuss these symptoms and side effects with your veterinarian.

Questions to Ask Yourself:
In Addition to the Items on the Questionnaire

What is the most important thing when considering my pet’s end-of-life treatment?
What are my thoughts about euthanasia?
Would I consider euthanasia if the following were true about my pet:

  • Feeling pain?
  • Can no longer urinate and/or defecate?
  • Starts to experience seizures?
  • Has become uncontrollably violent or is unsafe to others?
  • Has stopped eating?
  • Is no longer acting normally?
  • Has a condition that will only worsen with time?
  • Financial limitations prohibit treatment?
  • Palliative (hospice) care has been exhausted or is not an option?
  • The veterinary team recommends euthanasia, but the required symptoms or situations that I listed above are not present?
How Do I Know When It’s Time?

The following tools may aid you in making the decision to euthanise:

  • Enlist the help of your veterinarian. While your veterinarian cannot make the decision for you, it is helpful for him/her to know that you are considering euthanasia.
  • Remember how your pet looked and behaved prior to the illness. Sometimes changes are gradual, and therefore hard to recognise. Look at photos or videos of your pet from before the illness.
  • Mark good and bad days on a calendar. (Some may choose to distinguish morning from evening.) This could be as simple as a happy or sad face for good or bad. If the bad days start to outweigh the good, it may be time to discuss euthanasia.
  • Write a concrete list of three to five things your pet likes to do. When your pet is no longer able to enjoy these things, it may be time to discuss euthanasia.

Owner Details

Pet Details

Strongly Agree (Always) (Severe)Agree (Most of the time) (Significant)Neutral (Sometimes) (Mild)Disagree (Occasionally) (Slight)Strongly Disagree (Never) (None)
does not want to play
does not respond to my presence or does not interact with me in the same way as before
does not enjoy the same activities as before
is hiding
demeanor/behavior is not the same as it was prior to diagnosis/illness
does not seem to enjoy life
has more bad days than good days
is sleeping more than usual
seems dull and depressed
seems to be or is experiencing pain
is panting (even while resting)
is trembling or shaking
is vomiting and/or seems nauseous
is not eating well - (may only be eating treats or only if fed by hand)
is not drinking well
is losing weight
is having diarrhea often
is not urinating well
is not moving normally
is not as active as normal
does not move around as needed
needs my help to move around normally
is unable to keep self clean after soiling
has coat that is greasy, matted, or rough-looking
1 - Worse23 - Same45 - Better
Pet's overall health rating
1 - Poor2345 - Good
Pet's overall health rating