Pet Lameness Form | Visit Animal Surgical & Orthopedic Center

14810 15th Ave. NE, Shoreline, WA 98155 (206) 545-4322

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Lameness History Sheet

DATE

Patient

Client

1. Which Limb is involved:

Right Front

Left Front

Right Hind

Left Hind

a. Duration of lameness (Days/Weeks/Months):

b. Onset:

Acute (sudden)

Gradual

Was there an event (trauma or other) that started the lameness (briefly explain):

3. Overall the lameness has been:

Mild (barely noticeable)

Moderate

Severe (only slightly touching the leg down when walking)

Non-weight bearing (not using the leg at all)

4. Since the lameness started, it has:

Improved

Stayed the same

Progressively worsened

Intermittent in nature

5. Mark all that apply regarding the lameness

Worse following periods of increased activity

Worse first thing in the morning

Worse at the end of the day

Worse when first getting up from a lying position

Symptoms are consistent throughout the day

Has difficulty jumping or going up steps

Has difficulty going down steps

6. Currently my pet's activity is restricted to:

Controlled leashed walks only, no yard freedom

Preventing heavy off leashed activities (fetch, dog park, etc), still has yard/house freedom

No restrictions, normal activity

7. Prior to injury/lameness, my pet was:

Highly active/athlete/working dog

Moderately active (walks, hikes, swimming, play at parks, etc.)

Minimally active

8. Please list all medications (including amounts, timing) your pet is currently taking:

Improvement

No Change

Unsure

Improvement

No Change

Unsure

Improvement

No Change

Unsure

9. please note any of the following

a. Appetite:

Normal

Decreased

Absent

b. Vomiting:

Yes

C. Diarrhea:

Yes

D. Change in water intake:

Yes

Other information that might be helpful regarding my pet's condition:

Thank you. We'll be in touch regarding your pet's health.

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Surgery Rehabiliation

Location

14810 15th Avenue NE
Shoreline, WA 98155

(206) 545-4322

asoc@animalsurgical.com

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ASOC Clinic Hours
Monday to Friday: 8 AM – 6 PM
Saturday and Sunday: Closed
Major Holidays: Closed