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Quality of Life Evaluation
Quality of Life Evaluation
A guided evaluation for your pet's quality of life.
Your Pet's Details
Pet's Name
Animal Species
*
Dog
Cat
Weight
*
< 39 lbs
40 - 59 lbs
60 - 79 lbs
80 -99 lbs
> 100 lbs
Age
*
Rate your pet's overall health
*
0
1
2
3
4
5
6
7
8
9
10
0 -
Very Poor
10 -
Very Good
Social Functions
Desire to be with the family
*
Changes noticed
Some change noticed
No change noticed
Interaction with family or other pets.
*
Yes, interacts normally
Some change in interactions
No, does not interact normally
i.e., no increased aggression or other changes
Health
Breathing Patterns
*
Yes, changes in breathing
Some change in breathing
No change in breathing
Displays outward signs of pain.
*
Yes, increase in discomfort
Some change in discomfort
No change
Excessive panting, pacing, and whining are most commonly seen
Recent change in overall health condition
*
Yes, there has been change
Some change
No Change
Mental Health
Enjoys normal play activities?
*
Yes, plays like normal
Some change in desire to play
No, does not enjoy normal play activities.
Pacing around the house.
*
Yes, pacing has increased
Some pacing increase
No change in pacing
Confusion or apathy.
*
Yes, noticed an increase
Some change noticed
No, change in confusion or apathy
Outward signs of stress or anxiety.
*
Yes, displays stress or anxiety
Some stress or anxiety
No, stress or anxiety levels have not changed.
Still dislikes the same things.
*
Yes, changes to dislikes
Some changes
No changes in dislikes
"No" still hates the mailman, or "Yes" doesn’t bark at the mailman anymore
Nighttime activity
*
Normal nighttime behavior
Some change in nighttime behavior
Yes, changes in nighttime activity.
Natural Functions
Appetite
*
Normal appetite
Some change in appetite
Yes, definitely a change in appetite
Drinking
*
Normal drinking habits
Some change in drinking habits
Yes, changes noticed in drinking habits
Urination
*
Normal urination behavior
Some change in urination behavior
Yes, urination behavior has changed
Bowel movement habits
*
Normal bowel movements
Some change in bowel movements
Yes, change noticed.
Mobility
*
Normal mobility
Some change in mobility
Yes, recently less mobile
Receive Your Pet's Evaluation
Your First Name
*
Your Last Name
*
Email
*
Phone
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If you are human, leave this field blank.
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Quality of Life Evaluation
