Canine Osteoarthritis (OA) Survey

Canine Osteoarthritis (OA) Survey

This checklist is designed to help you recognize potential signs of osteoarthritis (OA) in your dog's activities and behaviors. Your doctor will review the results of this survey with you at your appointment to determine if your dog might be suffering from OA.
Dog's Name*
Cat's Name
Your Name*

First NameLast Name
Date of Your Dog's Scheduled Appointment*

MonthDayYear
Date
Think about your dog's activity in the past week. Is your dog exhibiting any signs of Osteoarthritis-related pain? Check all of the signs you've observed in your dog.*

Limping after exerciseLagging behind on walksSlow to riseDifficulty jumpingFeeling stiffDifficulty with stairsNo, my dog does not show any signs of OA-related pain
Do you think your dog shows signs of pain?

YesNo
Think about your dog's behavior in the past week. This scale helps measure your dog's pain based on how your dog is feeling. For each statement, select the number that most accurately describes your dog.
Energetic & Enthusiastic?*

0

1

2

3

4

5

6

0 is My dog couldn't be less, 6 is My dog couldn't be more
Happy & Content?*

0

1

2

3

4

5

6

0 is My dog couldn't be less, 6 is My dog couldn't be more
Active & Comfortable?*

0

1

2

3

4

5

6

0 is My dog couldn't be less, 6 is My dog couldn't be more
Calm & Relaxed?*

0

1

2

3

4

5

6

0 is My dog couldn't be less, 6 is My dog couldn't be more
If you checked or answered "yes" to any of these changes in behavior & activity, your dog may be experiencing osteoarthritis-related pain.

Osteoarthritis pain can affect dogs of all ages, breeds, and sizes. If left untreated, the pain can worsen over time. Your doctor will review the results of this survey with you at your appointment to determine if your dog might be suffering from OA.

This checklist is not a medical diagnostic tool and is not intended to replace discussion with an animal healthcare professional. Please discuss all medical concerns with your veterinarian.
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Canine Osteoarthritis (OA) Survey

Think about your dog's behavior in the past week. This scale helps measure your dog's pain based on how your dog is feeling. For each statement, select the number that most accurately describes your dog.

If you checked or answered "yes" to any of these changes in behavior & activity, your dog may be experiencing osteoarthritis-related pain.