Osteoarthritis questionnaire - Created Date 20 Apr, 2024

Cronulla Veterinary Clinic
37 Kingsway
Cronulla NSW 2230 AU
02 9527 2604
cronullavetclinic@gmail.com

EMAIL CALL

OSTEOARTHRITIS QUESTIONNAIRE

Identifying if your pet has osteoarthritis is essential in reducing any pain and discomfort and improving the pet's quality of life. Our veterinary team can help discuss the results of this health assessment and put together a plan towards a happier and healthier pet.

Please complete this questionnaire to help us best understand your pet's health needs.

Client Details

Client first name

Client last name

Phone number

Email address

Address

Pet Details

Animal name

Animal species (e.g. dog, cat)

Animal breed

Animal sex (e.g. male, female)

Animal age/DoB

Animal microchip

DETAILS OF SYMPTOMS

Have you noticed any of the following symptoms?
   Weight loss
   Weight gain
   Muscle loss
   Pain
   Swelling
   Lameness or limping
   Refusing to jump or climb stairs
   Reduced appetite
   Reluctance to move
   Difficulty rising from lying down
   House soiling
   Sleeping more
   Increased aggression when petted
   Decreased interest in exercise or walking
   Other

Other:

How long has your pet displayed these symptoms?
   Less than a week
   Less than a month
   A few months
   Less than a year
   More than a year

MOBILITY

How would you describe the mobility of your pet?
   Very good
   Good
   Fair
   Poor
   Very poor

How would you describe the mobility of your pet in cold weather?
   No effect
   Mild stiffness
   Moderate stiffness
   Severe stiffness

How would you describe the mobility of your pet after exercise?
   No effect
   Mild stiffness
   Moderate stiffness
   Severe stiffness

Please describe the types of exercise your pet receives each week.

PET'S WEIGHT

How would you describe the weight of your pet?
   Too thin
   Just right
   Too heavy

Please list any medications that your pet is currently on. Please include flea, heartworm, prescription medications, prescription diets and supplements.

OVERALL HEALTH

Apart from the behavioral changes described above, please describe any other health concerns.

By submitting this form, I acknowledge that I am the owner or agent representing the pet named above and that the information here is true and correct.

Date today

Connection problems

It looks like you are not currently connected to the internet.
Please check your internet connection before continuing.

CANCEL

LOGIN

Warning!

This chart is currently open on another device.
You may lose data if you edit this.

Continue

Exit Chart

Newer version of chart is available

There is a newer version of this chart available.
You will need to reload to get latest version.

Reload chart

Are you sure?

This will submit the Boarding chart and you won't be able to make any further changes.

Required fields.

The following ^* required fields need to be completed:

This website is subject to the Terms of Use and Privacy Policy . Information on or collected on a VetCheck Technologies Pty Ltd Service is provided for informational and educational purposes only. That information is not a substitute for professional health or other advice and is in no way intended to be used or relied upon to diagnose or treat the health condition of any animal, or as a prognosis of any health condition, or as pet owner consent or authorisation. Always seek the advice of or consult a health or other appropriate professional before relying on any information provided on a VetCheck Technologies Pty Ltd Service.

© VetCheck Technologies Pty Ltd. Used and/or modified with permission under license. This website in part or full cannot be reproduced in any form or by any means.