14810 15th Ave. NE, Shoreline, WA 98155
(206) 545-4322
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About
For Pet Owners
Existing Patients
New Patients
For Veterinarians
Contact
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:
No
Yes
C. Diarrhea:
No
Yes
D. Change in water intake:
No
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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