Liverpool Osteoarthritis in Dogs (LOAD)

Owner questionnaire for dogs with mobility problems

Dear Pet Owner

Thank you for agreeing to complete this questionnaire. Your assistance in this endeavor will enable us to gather valuable information about your pet and is a vital component in our ongoing quest to combat painful and debilitating diseases such as arthritis. It is important that all questions are answered to the best of your ability and if you have a question regarding the questionnaire, please contact us.

Thank you again for your help.

Today’s date: *

Please choose which hospital you'd like to send it to: *

Noes Ark
Bark Avenue

Owner’s name: *

First

Last

Client number:

Email *

Owner’s phone number: *

Pet’s name: *

Breed of pet: *

Pets age: *

Sex: *

Male
Female

Background

1. 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

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

Please list these if you can:

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

Lifestyle

1. 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

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

0
1
2
3
4
more than 4

3. What type of exercise is this? *

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

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

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

(Check more than one box if necessary.)

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

On level grass
In woodland
On street
Over rough ground

6. At exercise, how is your dog handled? *

Walk on leash
Walk off leash
Trot

7. Who limits the extent to which your dog exercises? *

You
Your dog

Mobility

1. How is your dog’s mobility in general? *

Very good
Good
Fair
Poor
Very poor

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

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

3. How active is your dog? *

Extremely active
Very active
Moderately active
Slightly active
Not at all active

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

No effect
Mild effect
Moderate effect
Severe effect
Extreme effect

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

No stiffness
Mild stiffness
Moderate stiffness
Severe stiffness
Extreme stiffness

6. At exercise, how active is your dog? *

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

7. How interested is your dog in exercising? *

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

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

Very good
Good
Fair
Poor
Very poor

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

No effect
Mild effect
Moderate effect
Severe effect
Extreme effect

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

Never
Hardly ever
Occasionally
Frequently
Very frequently

11. 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

12.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

13. 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

Get In Touch

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Contact Us

Call: 480-210-5610 ext. 1
Text: 480-571-5008
Fax: 480-807-5542
Email: hospital@barkavepet.com

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Location

3109 E McKellips Rd
Mesa, AZ 85213

Click here for directions.

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Hours

Mon – Fri: 7:30 AM – 7:00 PM
Sat – Sun: 8:00 AM – 2:00 PM

Click here to make an appointment.

Have a question?

Complete the form below and our team will be in touch with you shortly. If you’re in need of immediate assistance, please contact us directly at 480-210-5610 ext. 1.

Name *

First

Last

Email *

Phone

How can we help you? *