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Non Surgical Owner Assessment

Please list current medications and any other medical conditions/Injuries (include dates if condition or injury was in the past):

If condition is due to an accident, when did your pet’s injury occur? How?

If non-traumatic in origin, how long has your pet had symptoms?

Has your pet been getting better or worse?

What aggravates the problem?

What eases the problem?

Have there been any new playing or working activities introduced to your pet?

Is the problem/pain affected by time of day or activity?

What specific functional problems is your pet having? (Example: rising from lying down on tile floors)

What other treatments has your pet received for this problem? When?

What commands does your pet follow (i.e. Sit? Heel?)? What is the word you use for “treats”?

May your pet receive Science Diet treats during the therapy session? (If not, please bring appropriate treats for your pet.)

What is your pet’s favorite motivator? (Ball? Treats? Petting?)

How many caregivers for your pet are in the home?

What specific goals do you have for your pet’s recovery? (Examples: (1) Climb 4 stairs into home without assistance, (2) Resume jogging 3 miles with me, (3) Regain strength to play with children, (4) Return to hunting.)

Your Pet's Activity Levels

Please select one number on each of the five scales to indicate your pet’s current
activity levels.





Owner's Perception of Pet's Quality of Life

Additional Comments: