Patient's first and last name
How long have you had your pet?
Is there a family history (parents or siblings) of orthopedic disease that you know of?
Please list all the medications and supplements your dog is taking
What food is your dog eating?
Is there any history of past trauma (e.g., hit by a car) or is your pet a rescue with unknown history?
Has your pet had similar issues before this current concern?
How long has your pet been suffering from their current problem?
Please describe what you are seeing that has made you seek care
Is it worse after exercise, before exercise, or during?
Select...
After exercise
Before exercise
During exercise
No difference
Does your dog have difficulty navigating stairs or getting on furniture or into the car?
Are there areas of your home or daily routes that your pet struggles with?
In an average week how far do you think your dog has exercised each day?
In the last week on average how many walks has your dog had each day?
Is there a day of the week upon which your dog has significantly more exercise?
What kind of terrain does your dog most often exercise on?
Select...
Level grass
Woodland
Street
Rough hill ground
Who limits the extent to which your dog exercises?
At exercise, how is your dog handled?
Select...
Walks on leash
Walk off leash
Trots on leash
Runs freely
What does a normal day look like now? (Exercise, rest, etc.)
Does your pet participate in any kind of dog sport?
What are your goals with rehabilitation? This could be as simple as your pet walking up some stairs or as complex as returning to a sport
Does anyone in your household have a pacemaker, insulin pump, holder monitor, freestyle libre or other implanted functioning device? (We may use pulsed electromagnetic field therapy during our exam)
We use a variety of treats. Does anyone in your home or your pet have an allergy? Peanut butter is one of our favorite treats
What is your pet’s favorite treat?
Who lives in your house? (Please provide names and pronouns for the humans, other pets, etc.)
How much time per day are you expecting to spend on home exercises and treatments?
Are there any human disabilities or restrictions that we need to know about that would affect your family being able to perform home exercises?
Does this pet go back and forth between two households?
How is your pet about lying on their side for an exam?
Has your pet ever required pre-visit medication to see the vet?
Has your pet every required a muzzle? It’s ok if they have we just need to come prepared
How does your pet behave when strangers come to your home?
Do you have pet insurance and if so which one?
Can we share your pet’s picture on social media?
Is there anything else you would like us to know about yourself or your pet?
Upload any videos of possible pain behaviors or your pet’s gait here
Upload a video in MPEG,MP4, MOV, AVI, or MKV format, up to 30 MB and a maximum of 1 minute in length. If you have uploaded a video, please be patient as the form may take longer to submit. Do not close or refresh the window during this time.
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