Quality of Life Scale

Name

Email Address

Contact Number

Pet Name

Still interacts with family (not isolating). Still interacts with family (not isolating). *012345

Interacts the same with family and other pets, no increase in aggression. Interacts the same with family and other pets, no increase in aggression. *012345

Does not seem confused or lost. Does not seem confused or lost. *012345

No signs of stress or anxiety. No signs of stress or anxiety. *012345

No changes in breathing, or panting such as panting or pacing. No changes in breathing, or panting such as panting or pacing. *012345

Night time activity the same. Night time activity the same. *012345

Appetite the same. Appetite the same. *012345

Drinking the same (not Increased or decreased). Drinking the same (not Increased or decreased). *012345

Urination the same. Urination the same. *012345

Bowel habits the same. Bowel habits the same. *012345

Ability to get up unchanged. Ability to get up unchanged. *012345

Ability to walk unchanged. Ability to walk unchanged. *012345

Not stiff or limping. Not stiff or limping. *012345

Still greets people at the door. Still greets people at the door. *012345