Cushing’s Quality-of-life Questionnaire

Completing this questionnaire will help your vet understand how your dog is progressing and how Vetoryl® is working to bring back health and restore life.

Please choose the category that best describes how your dog is currently for each question.

Client Name (as it would appear on our database)

First NameLast Name

Pet's Name

CLINICAL IMPACT

Rows	Never - 0	Occasionally - 1	Often - 2	All the time - 3
My dog is excessively thirsty
My dog urinates in the house
My dog is excessively hungry
My dog pants excessively

DOG’S DEMEANOUR

Rows	Never - 0	Occasionally - 1	Often - 2	All the time - 3
My dog is depressed and quiet
My dog has no energy
My dog doesn’t want to interact with other people/dogs
My dog is reluctant to play with me
My dog seems disorientated/confused

PHYSICAL IMPACT

Rows	Never - 0	Occasionally - 1	Often - 2	All the time - 3
I struggle with my dog’s weight
My dog’s hair coat is in a poor condition
My dog’s skin appears to be uncomfortable (e.g. dry/tight)
My dog appears to be in a poor physical condition (e.g. muscle loss/pot bellied)
My dog struggles to walk very far

OWNER IMPACT

Rows	Never 0 Points	Occasionally 1 Points	Often 2 Points	All the time 3 Points
I worry about the future health of my dog
Mine and my dog’s daily routine is disrupted
I feel I am struggling to manage my dog’s health
I feel the bond between me and my dog is lacking
I feel my dog’s appearance attracts negative comments

Total Score

Scores nearest to 0 indicate the best possible quality-of-life.
Scores nearest to 1 indicate the worst possible quality-of-life.

Score Result (total score divide by 57)

Changes in the score can be monitored over time.
To help you interpret the changes in score, please see the scale below: