Your Pet's Journey: A Quality of Life Questionnaire

Your Pet's Journey: A Quality of Life Questionnaire

When assessing your pet's quality of life, we need to consider both physical comfort and emotional wellbeing. Every pet has their own individual needs and preferences. This questionnaire helps you evaluate your pet's daily condition while respecting the special bond you share. At Hold My Paws, we provide guidance through this process, focusing on your pet's dignity and comfort in all decisions.
Today's Date

MonthDayYear
Pet's Name*
Pet's Current Age*
Pet's Current Weight*
Type of Pet*
Phone Number*

More information about your pet's individual case, diagnosis etc.
This helps us to further assess their comfort, and together we can make a plan for your pet.
If you would like the Hold Your Paws team to contact you about your score and book a consultation with our Veterinarian to discuss Palliative Care or Home euthanasia, please select the option below.*

Yes I would like to discuss Palliative CareYes, I would like to discuss Home EuthansiaNoOther
Other enquires

Quality of Life Score

Please reach out to our team if you need any support or have any questions about the score. If you have a score of 75 or below, please reach out to our team or your normal vet for advice.
Quality of Life Score
Score out of 125. The lower the number, the lower the quality of life.
Your Name*

First NameLast Name
Email*
example@example.com
Don't forget to click submit to receive an email with a copy of the completed questionnaire and your pet's quality of life score.

Please note this may take a few minutes to come through.
Should be Empty:

	Strongly Agree (All the Time) (Severe)	Agree (Most of the Time) (Significant)	Neutral (Sometimes) (Mild)	Disagree (Occasionally) (Slight)	Strongly Disagree (Never) (None)
My pet does not want to play with me or others
My pet does not respond to my presence or does not interact with me in the same way as before
My pet does not enjoy the same activities as before
My pet is hiding more than usual
My pet's demeanour/behaviour is not the same as it was prior to diagnosis/illness
My pet does not seem to enjoy every day life
My pet has more bad days than good days
My pet is sleeping more than usual

	Strongly Agree (All the Time) (Severe)	Agree (Most of the Time) (Significant)	Neutral (Sometimes) (Mild)	Disagree (Occasionally) (Slight)	Strongly Disagree (Never) (None)
My pet seems dull and depressed
My pet seems to be or is experiencing pain
My pet is panting (even while resting)
My pet is trembling or shaking
My pet is vomiting and/or seems nauseous
My pet is not eating well - (may only be eating treats or only if fed by hand)
My pet is drinking less or not at all
My pet is losing weight or body condition

	Strongly Agree (All the Time) (Severe)	Agree (Most of the Time) (Significant)	Neutral (Sometimes) (Mild)	Disagree (Occasionally) (Slight)	Strongly Disagree (Never) (None)
My pet is not moving around normally
My pet is not as active as normal
My pet does not move around as needed
My pet needs my help to move around normally
My pet is unable to keep themselves clean/groom themselves
My pet's fur is greasy, matted, or rough-looking

Quality of Life Score