Name
First Name
Last Name
Email
*
Are they in pain?
*
Do they shake, tremble or pant even when they are resting?
Yes
Maybe
No
*
Do they hide away and not want to be touched or stroked?
Yes
Maybe
No
*
Does it seem to you that their pain medication has stopped working?
Yes
Maybe
No
Mobility
*
Is your dog slowing down on walks or wanting to go for a walk less?
Yes
Maybe
No
*
Are they struggling with stairs, getting onto a sofa or bed, or stiff on rising?
Yes
Maybe
No
*
Are they limping, dragging or scuffing their feet, wobbly or falling over?
Yes
Maybe
No
*
Do they pant more than usual or seem to be struggling for breath?
Yes
Maybe
No
Appetite
*
Have they lost interest in food, even turning down their favourite treats?
Yes
Maybe
No
*
Are they reluctant to eat hard foods or have their teeth checked?
Yes
Maybe
No
*
Are they chewing more on one side of their mouth?
Yes
Maybe
No
Weight Gain
*
Has your pet gained weight quite suddenly?
Yes
Maybe
No
*
Do they have a fatter belly than they used to?
Yes
Maybe
No
Weight Loss
*
Has your pet lost weight or muscle condition even though they are being fed the same amount of food
Yes
Maybe
No
Behaviour
*
Is your pet looking depressed, lethargic, looking sad or disinterested in life?
Yes
Maybe
No
*
Have they stopped greeting you when you come home?
Yes
Maybe
No
*
Are they hiding or sleeping in strange places?
Yes
Maybe
No
*
Do they spend nearly all their time sleeping?
Yes
Maybe
No
*
Have they become grumpier?
Yes
Maybe
No
*
Have they stopped being interested in what's going on around them?
Yes
Maybe
No
Confusion
*
Does your pet have episodes of looking confused, staring into space, vocalising, bumping into things or aimlessly pacing?
Yes
Maybe
No
*
Have they started waking during the night or become more anxious?
Yes
Maybe
No
Toileting
*
Has your dog started having accidents or urgency to go to the toilet when they were previously house trained?
Yes
Maybe
No
*
Has your cat stopped using the litter tray?
Yes
Maybe
No
*
Is your pet pooing or weeing where they rest?
Yes
Maybe
No
Drinking
*
Is your pet drinking more than usual or urinating more frequently?
Yes
Maybe
No
Coat
*
Do they smell of wee or can't keep their bum clean?
Yes
Maybe
No
*
Is your pets fur becoming matted because they no longer take an interest in grooming themself?
Yes
Maybe
No
*
Do they have new pressure sores on their joints due to not being able to look after themselves?
Yes
Maybe
No
Quality of Life
*
Are they having more bad days than good days?
Yes
Maybe
No
*
Is your pet finding it very stressful being medicated?
Yes
Maybe
No
Care
*
Is looking after your pet becoming more challenging than it used to be? Do you feel overwhelmed by caring for them?
Yes
Maybe
No
*
Do you feel you can no longer meet their needs or manage to medicate them?
Yes
Maybe
No