Lameness History Form Please fill out our online Lameness History Sheet Form below. Please enable JavaScript in your browser to complete this form.DatePatient *Client *Email *Which limb is involved? (Check all that apply)Right FrontLeft Front Right Hind Left Hind Duration of lameness Specify days/weeks/months Onset of lamenessAcute (sudden)Gradual Was there an event (trauma or other) that started the lameness?Yes No If yes, please describe brieflyOverall, the lameness has been: Mild (barely noticeable)ModerateSevere (only slightly touching the leg down when walking)Non-weight bearing (not using leg at all)Since the lameness has started, it has:Improved Stayed the same Progressively worsened Been intermittent Mark all that apply about the lameness Worse following periods of increased activityWorse first thing in the morningWorse at the end of the dayWorse when first getting up from a lying positionSymptoms are consistent throughout the dayHas difficulty jumping or going up stepsHas difficulty going down stepsCurrently, my pet's activity is restricted to: Controlled leashed walks only, no yard freedomPreventing heavy off leashed activities (fetch, dog park etc), still has yard/house freedomNo restrictions, normal activityPrior to injury/lameness, my pet was Highly active/athlete/working dogModerately active (walks, hikes, swimming, play at parks, etc.)Minimally active List all current medications, dose & timing. One per line, check appropriate box underneathSymptoms improvedNo change Unsure Symptoms improvedNo change Unsure Symptoms improved No change Unsure Please list any additional medications or supplements not included above. Please note the following: Appetite Normal Decreased Absent Vomiting YesNo Explain Diarrhea Yes No ExplainChange in water intake YesNoExplainOther information that might be helpful about your pet's conditionSubmit
