Quality of Life Questionnaire

Save time before your appointment by completing the required form online from any device at your convenience. Providing complete and accurate information helps us better understand you and your pet’s needs, ensuring compassionate and personalized care.

Owner & Pet Information

Your Name(Required)
Physical Address(Required)
Sex(Required)
Date of Birth(Required)
MM slash DD slash YYYY
Survey Date(Required)
MM slash DD slash YYYY

Behavior & Attitude

My pet does not want to play(Required)
My pet does not respond to my presence or does not interact with me in the same way as before(Required)
My pet does not enjoy the same activities as before(Required)
My pet is hiding(Required)
My pet's demeanor/behavior is not the same as it was prior to diagnosis/illness(Required)
My pet does not seem to enjoy life(Required)
My pet has more bad days than good days(Required)
My pet is sleeping more than usual(Required)
My pet seems dull and depressed(Required)

Pain & Physical Symptoms

My pet seems to be or is experiencing pain(Required)
My pet is panting (even while resting)(Required)
My pet is trembling or shaking(Required)
My pet is vomiting and/or seems nauseous(Required)

Nutrition & Hydration

My pet is not eating well (may only be eating treats or only if fed by hand)(Required)
My pet is not drinking well(Required)
My pet is losing weight(Required)
My pet is having diarrhea often(Required)
My pet is not urinating well(Required)

Mobility

My pet is not moving normally(Required)
My pet is not as active as normal(Required)
My pet does not move around as needed(Required)
My pet needs my help to move around normally(Required)

Hygiene

My pet is unable to keep self clean after soiling(Required)
My pet has a coat that is greasy, matted, or rough-looking(Required)

Overall Health Rating

Overall, how would you rate your pet's health compared to before?
Overall, how would you rate your pet's quality of life today?

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We proudly serve the pets of Sheridan and the surrounding areas. We look forward to seeing you! Request an appointment by clicking the button below.

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