Quality of life checklist

1

Do they shake, tremble or pant even when they are resting?* This field is required.

Yes

Maybe

No

2

Do they hide away and not want to be touched or stroked?* This field is required.

Yes

Maybe

No

3

Does it seem to you that their pain medication has stopped working?* This field is required.

Yes

Maybe

No

4

Is your dog slowing down on walks or wanting to go for a walk less?* This field is required.

Yes

Maybe

No

5

Are they struggling with stairs, getting onto a sofa or bed, or stiff on rising?* This field is required.

Yes

Maybe

No

6

Are they limping, dragging or scuffing their feet, wobbly or falling over?* This field is required.

Yes

Maybe

No

7

Do they pant more than usual or seem to be struggling for breath?* This field is required.

Yes

Maybe

No

8

Have they lost interest in food, even turning down their favourite treats?* This field is required.

Yes

Maybe

No

9

Are they reluctant to eat hard foods or have their teeth checked?* This field is required.

Yes

Maybe

No

10

Are they chewing more on one side of their mouth?* This field is required.

Yes

Maybe

No

11

Is your pet drinking more than usual or urinating more frequently?* This field is required.

Yes

Maybe

No

12

Has your pet gained weight quite suddenly?* This field is required.

Yes

Maybe

No

13

Do they have a fatter belly than they used to?* This field is required.

Yes

Maybe

No

14

Has your pet lost weight or muscle condition even though they are being fed the same amount of food* This field is required.

Yes

Maybe

No

15

Is your pet looking depressed, lethargic, looking sad or disinterested in life?* This field is required.

Yes

Maybe

No

16

Have they stopped greeting you when you come home?* This field is required.

Yes

Maybe

No

17

Are they hiding or sleeping in strange places?* This field is required.

Yes

Maybe

No

18

Do they spend nearly all their time sleeping?* This field is required.

Yes

Maybe

No

19

Have they become grumpier?* This field is required.

Yes

Maybe

No

20

Have they stopped being interested in what's going on around them?* This field is required.

Yes

Maybe

No

21

Does your pet have episodes of looking confused, staring into space, vocalising, bumping into things or aimlessly pacing?* This field is required.

Yes

Maybe

No

22

Have they started waking during the night or become more anxious?* This field is required.

Yes

Maybe

No

23

Has your pet started having accidents or urgency to go to the toilet when they were previously house trained?* This field is required.

Yes

Maybe

No

24

Is your pet pooing or weeing where they rest?* This field is required.

Yes

Maybe

No

25

Do they smell of wee or can't keep their bum clean?* This field is required.

Yes

Maybe

No

26

Is your pets fur becoming matted because they no longer take an interest in grooming themselves?* This field is required.

Yes

Maybe

No

27

Do they have new pressure sores on their joints due to not being able to look after themselves?* This field is required.

Yes

Maybe

No

28

Are they having more bad days than good days?* This field is required.

Yes

Maybe

No

29

Is your pet finding it very stressful being medicated?* This field is required.

Yes

Maybe

No

30

Is looking after your pet becoming more challenging than it used to be? Do you feel overwhelmed by caring for them?* This field is required.

Yes

Maybe

No

31

Do you feel you can no longer meet their needs or manage to medicate them?* This field is required.

Yes

Maybe

No

32

Health scoreFor a score above x

33

Name

First Name

Last Name

34

Email

example@example.com