LOAD Questionnaire

Please complete this questionnaire before your initial visit

Please select your practice

Pet Details

Background

How long has your pet been suffering with his/her mobility problem?:
Has your dog been diagnosed as suffering from any other problems in addition to his/ her orthopedic disease?:

Lifestyle

In the last week, on average, how far has your dog exercised each day?:
In the last week, on average, how many walks has your dog had each day?:
What type of exercise is this?:
Are there particular days of the week upon which your dog has significantly more exercise? (Check more than one box if necessary):
On what sort of terrain does your dog most often exercise?:
At exercise, how is your dog handled?:
Who limits the extent to which your dog exercises?:

Mobility

Generally

How is your dog’s mobility in general?:
How disabled is your dog by his/her lameness?:
How active is your dog?:
What is the effect of cold, damp weather on your dog’s lameness?:
To what degree does your dog show stiffness in the affected leg after a ‘lie down’?:
At exercise, how active is your dog?:
How interested is your dog in exercising?:

At exercise

How would you rate your dog’s ability to exercise?:
What overall effect does exercise have on your dog’s lameness?:
How often does your dog rest (stop/sit down) during exercise?:
What is the effect of cold, damp weather on your pet’s ability to exercise?:
To what degree does your dog show stiffness in the affected leg after a ‘lie down’ following exercise?:
What is the effect of your dog’s lameness on his/her ability to exercise?:
Security Question: