Canine Orthopedic Index Canine Orthopedic Index Your Name* First Last Your Email* Today's Date* MM slash DD slash YYYY Description of StiffnessThe following questions concern the amount of joint stiffness your dog has experienced in the past 7 days. Stiffness is the restriction or slowness in the ease with which your dog moves his/her joints. Please select one answer for each question below.How severe is your dog's stiffness after first wakening in the morning?* None Mild Moderate Severe Extreme Later in the day, how severe is your dog's stiffness after lying down for at least 15 minutes?* None Mild Moderate Severe Extreme How much of a problem does your dog have rising to standing after lying down for at least 15 minutes?* No problems Mild problems Moderate problems Severe problems Extreme problems In general, over the past 7 days, how much difficulty has your dog had with his or her joints?* None Mild Moderate Severe Extreme Description of FunctionPlease indicate how much of a problem each of the following activities has been for your dog over the past 7 days. Please select one answer for each question below.Jumping up (as in getting into the car or onto the bed) ?* No problems Mild problems Moderate problems Severe problems Extreme problems Jumping down (as in getting out of the car or off of the bed) ?* No problems Mild problems Moderate problems Severe problems Extreme problems Climbing up (as in stairs, ramps or curbs) ?* No problems Mild problems Moderate problems Severe problems Extreme problems Climbing down (as in stairs, ramps or curbs) ?* No problems Mild problems Moderate problems Severe problems Extreme problems Description of GaitThe following questions concern your dog’s gait over the past 7 days. Gait refers to the manner in which your dog uses its legs as it moves. Please select one answer for each question below.On average, how severe was your dog's limp during mild activities (such as short walks)?* None Mild Moderate Severe Extreme On average, how severe was your dog's limp during moderate activities (such as long walks, playing or running)?* None Mild Moderate Severe Extreme How often did your dog limp the day after moderate activities (such as long walks, playing or running)?* Never Rarely Occasionally Frequently Constantly How often have you been aware of your dog's joint problems?* Never Rarely Occasionally Frequently Constantly How often did your dog 'pay' for over-activity, with increased pain or stiffness the following day?* Never Rarely Occasionally Frequently Constantly Description of Quality of LifePlease select one answer for each question below.In the past 7 days, what has been your level of concern that your dog's joint problems will shorten his or her life?* None Mild Moderate Severe Extreme In the past 7 days, what has been your level of concern that your dog is generally slowing down?* None Mild Moderate Severe Extreme Overall, how would you rate your dog's quality of life over the past 7 days?* Excellent Very Good Good Fair Poor CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ
