Quality of Life Survey

Click the number that best describes your pet in the form to help assess your pet’s overall wellbeing. 

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Quality of Life Survey

Please fill out the form completely and click the number that best describes your pet. Once completed, please share this form with your veterinarian so they can help assess your pet’s overall wellbeing. 

Disagree (1)2Neutral (3)4Agree (5)
My pet wants to play
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet responds to my presence
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet enjoys life
Disagree (1)
2
Neutral (3)
4
Agree (5)
Disagree (1)2Neutral (3)4Agree (5)
My pet has more good days than bad days
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet sleeps more, is awake less
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet seems dull or depressed, not alert
Disagree (1)
2
Neutral (3)
4
Agree (5)
Disagree (1)2Neutral (3)4Agree (5)
My pet is in pain
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet pants frequently, even at rest
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet shakes or trembles occasionally
Disagree (1)
2
Neutral (3)
4
Agree (5)
Disagree (1)2Neutral (3)4Agree (5)
My pet eats the usual amount of food
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet acts nauseous or vomits
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet eats treats/snacks
Disagree (1)
2
Neutral (3)
4
Agree (5)
Disagree (1)2Neutral (3)4Agree (5)
My pet keeps him/herself clean
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet smells like urine or has skin irritation
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet’s hair is greasy, matted, rough looking
Disagree (1)
2
Neutral (3)
4
Agree (5)
Disagree (1)2Neutral (3)4Agree (5)
My pet drinks adequately
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet has diarrhea
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet is urinating a normal amount
Disagree (1)
2
Neutral (3)
4
Agree (5)
Disagree (1)2Neutral (3)4Agree (5)
My pet moves normally
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet lays in one place all day long
Disagree (1)
2
Neutral (3)
4
Agree (5)
My pet is as active as he/she has been
Disagree (1)
2
Neutral (3)
4
Agree (5)
Worse (1)2Similar (3)4Better (5)
General health compared to last evaluation
Worse (1)
2
Similar (3)
4
Better (5)
General health compared to initial diagnosis
Worse (1)
2
Similar (3)
4
Better (5)
Very Poor Excellent