Arthritis Questionnaire
Owner name:
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Patient name:
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In general, how do you rate your pet's health?
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Very good
Good
Fair
Poor
Has your pet ever seen a healthcare provider for joint pain, stiffness, or limping? If yes, Please explain:
Living with pain can cause changes in behavior; this can be hard to read in a pet. On average, would you say your pet is:
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Uninterested in their surroundings, mostly sleeps
Will show interest, but no longer comes to greet you
Plays only when encouraged, and not for long
Has had no change in personality
Does your pet have pain, swelling, warmth, or stiffness in one or more legs?
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Yes, in one joint
Yes, in a few joints
Yes, in many joints
No/Unknown
Has your pet had a joint or bone injury or surgery? If yes, please describe:
Did your pet's signs begin slowly or suddenly?
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Slowly, over the course of months
Suddenly, within a few days or weeks
Other
In the morning, are the affected areas stiff for more than 30 minutes?
Yes
No
There is no morning stiffness
On any given day, how long does the joint stiffness last?
Less than 30 minutes
30 min to 1 hour
More than 1 hour
There is no joint stiffness
Has the joint stiffness worsened within the past few days or weeks?
Yes
No
Which methods have you or do you use to manage pain, stiffnes, or swelling?
Physical activity/exercise
Nutritional supplements (fish oil, vitamins, etc)
Weight management
Chiropractic/massage/physical therapy
Cold or heat treatment
Prescription medication
Over the counter joint supplements
Other (please specify):
Which over the counter medications or joint supplements do you currently use?
Aspirin
Veterinary joint supplement
Herbal supplement
Other
Does your dog have any of the following conditions? Check all that apply:
Kidney disease
Liver disease
Lung disease
Cardiovascular disease
Skin disease/allergies
Active infection
Bladder problems
None of the above
Other
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