Quality of Life questionnaire

The quality of life scale has been formulated based on our personal experiences with thousands of pets and their owners. It is an easy and accessible way to better assess how your pet is doing right now, using your own impressions and information you can gather at home.

This free assessment can help make this difficult time a little easier by giving you more objective criteria on which to base your pet’s current state of health.

• Unique scale takes into account 10 different facets of your pet’s current condition.
• Easy to complete, only takes 5 minutes
• Score can be tracked from week to week so an objective assessment of your pet’s health can be made

We understand how difficult this time can be, and how important it is to feel comfortable and confident in the decision you make. At Transitions we strive to make this time as peaceful and stress-free as possible for you and all your family members.

We are here to answer any questions you may have, and to accommodate your needs as best we are able. We hope this quality of life scale will provide you with peace of mind as you move through this process.

Welcome to your Quality of Life

Appetite:

My pet now...*

eats normally- i.e. eats the same type of food, and finishes in the same amount of time compared to 6 months ago

will still eat regular food but takes longer to finish

does not want to eat regular food but will still eat treats or people food

acts interested in food but walks away from the bowl without eating

cannot be enticed to eat no matter what I offer them

None

Hydration:

My pet now...*

drinks, and urinates the same amount as they did 6 months ago

has had a minor change (>25% volume) in the amount they drink, or frequency/ amount of urination compared to 6 months ago

has had a noticeable change (25-50%) in the volume they drink, but their urination seems normal. Feces are a little harder/ drier than they were 6 months ago, but defecation frequency is normal

has had a change of <50% in the volume they drink, and urinates abnormally-frequency, volume, or ease of urination has changed. Feces are harder, drier and less frequent than 6 months ago.

has had a change of <75% in the volume they drink, and urinates abnormally- frequency, volume, or ease of urination has changed. Feces are hard, dry and infrequent.

None

Weight loss:

My pet now...*

weighs and looks the same as 6 months ago

has lost some weight but does not look/ feel any different than 6 months ago

has lost weight, and I can feel their skeleton more prominently than I did 6 months ago

has lost weight, and I can see the change in how they look compared to 6 months ago

has lost >20% of body weight compared to 6 months ago, and I can easily see and feel their bones

None

Appearance:

My pet’s coat now...*

looks sleek and shiny

is a little dull, but I still notice my pet grooming

has changed in appearance-e.g. duller, thinner, skin is more flaky

has changed in appearance and I do not notice my pet grooming as regularly

is dull and lifeless and I have not noticed my pet grooming

None

Toileting for cats:

My pet now...*

Uses the litter box normally

Uses the litter box most of the time, but will urinate/ defecate in other places <50% of the time

Urinates/ defecates outside the litter box >50% of the time

Does not use the litter box for urination and/or defecation

Will urinate and/or defecate where they are sleeping or resting

None

Toileting for dogs:

My pet now...*

Urinates and defecates normally

Urinates/ defecates normally most of the time but I will find urine or feces in the house <50% of the time

Has changes in the frequency or appearance of their urination or defecation

Appears to have difficulty urinating or defecating, or will urinate/defecate in the house >50% of the time

Will urinate and/or defecate where they are sleeping or resting

None

Mobility for cats:

My pet now...*

Moves around normally, and jumps/ climbs stairs as much as 6 months ago

Seems to have some difficulty moving around, and is less willing to jump than 6 months ago

Spends longer lying than they used to, but will still get up when I come to the door, or to eat and drink

No longer jumps or climbs stairs, and is reluctant to rise for food or water, or for rewards they used to enjoy-e.g. treat, owner arriving home from work

Can no longer get up

None

Mobility for dogs:

My pet now...*

Moves around normally, and walks/ climbs stairs as much as 6 months ago

Seems to have some difficulty moving around, and is less willing to go on walks, or takes shorter walks than they did 6 months ago.

Spends longer lying than they used to, but will still get up when I come to the door, or to eat and drink

Is not interested in going on walks, no longer climbs stairs and is reluctant to rise for food or water, or for rewards they used to enjoy-e.g. treat, owner arriving home from work

Can no longer get up without assistance or falls regularly

None

Activity level for cats:

My pet now...*

Plays and interacts with the family as much as 6 months ago

Will get up to eat and drink, and/or to greet me, but is more reluctant to play than 6 months ago

Shows interest when I get home, but will not get up

Is hard to find when I get home, and is hiding more

Shows no interest in me, and is not interested in any stimuli- treats etc.

None

Comfort level:

My pet now...*

Does not seem uncomfortable

Seems uncomfortable <25% of the time, i.e. is slow to rise in morning, limps only at end of walk.

Has difficulty getting up, or lying down, or has a limp

Seems uncomfortable >50% of the time

Shows overt signs of pain- vocalization, change in temperament, hiding

None

Sleep:

My pets sleep habits...*

Have not changed

Have changed; they sleep more during the day, but nighttime sleeping is the same as 6 months ago

Have changed; they sleep more and are harder to rouse than they were 6 months ago

Have changed; my sleep is disrupted by their nocturnal behavior some nights

Are significantly different than they were 6 months ago and my sleep is disrupted >50% of the time

None

Quality of life:

My pet now...*

Has not had any change in their quality of life

Has had some change in their quality of life, but the good times outnumber the bad >75% of the time

Has had a change in their quality of life, and I am concerned about their quality of life 50% of the time

Has had a significant change in the quality of their life 75% of the time, and I am starting to think about euthanasia

Has more bad days than good days, and I am very concerned about their quality of life, I have thought about euthanasia a lot

None

Full Name

Email Address

Phone

Additional Info or comments?

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