Quality of Life Survey

Quality of Life

At Liberty Pet Hospital we know it can be hard to see your fur baby decline. We hope that by using our Quality of Life scale below it will help you and your family decide when your beloved pet deserves to pass with dignity to relieve any pain or discomfort they may be experiencing.

Please consider quality of life versus basic existing. Eating, drinking, sleeping, urinating and defecating are normal, everyday functions. These daily functions may change as your pet’s condition progresses but there are other things to consider that truly measure quality of life.

We hope this scale will help give you an objective perspective of your pet’s overall well-being.

Once you fill out the survey, a member of our team will be in touch with you shortly to discuss your results.

Activity *

3 - My pet expresses joy when interacting with family, toys
2 - My pet shows some interest in interacting with family, toys but less often than when healthy
1 - My pet shows little happiness in interacting with family, toys, etc
0 - My pet shows no interest in family, toys and may be avoiding family, normal places of rest

Appetite *

3 - My pet is eating normal meals at a normal pace without assistance
2 - My pet is eating normal meals but slower and sometimes needs special toppings to encourage them
1 - My pet isn’t eating a normal meal and will only eat treats, people food, and sometimes skips meals
0 - My pet refuses to eat anything I offer them

Cleanliness *

3 - My pet is able to stay well groomed, clean and free from matted fur and odors
2 - My pet is able to stay well groomed, clean and free from matted fur or odor, but requires some assistance by me to maintain them
1 - My pet is having trouble getting groomed (professionally or by me) and needs help remaining free of matted fur, odors/soiling
0 - My pet is unable to stay clean and odor free without help from me

Mobility *

3 - My pet is able to get around well, eliminate without assistance, jump/use stairs
2 - My pet needs some help getting around, is having some trouble eliminating without assistance, and needs some help to navigate some stairs/furniture
1 - My pet lays in one area most of the day, struggles to get around without assistance and needs help with elimination, and has limited use of stairs/jumping
0 - My pet cannot move about without assistance, makes no effort to get up when coaxed

Favorite Things *

3 - My pet enjoys their favorite activities (walks, car rides, lounging in the sun, etc)
2 - My pet shows less interest in their favorite activities
1 - My pet shows little interest in their favorite activities
0 - My pet shows no interest in their favorite activities

Your Name *

First

Last

Email *

Phone *

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Would you like someone from our office reach out to schedule a consultation? *

Preferred method of contact? *

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Phone

We put your pet first.

Please do not hesitate to contact us with any questions you may have. We look forward to providing compassionate and customized care to your pet during each and every visit.

Address

8730 Moreland St.
Powell, OH 43065
Click here for directions.

Hours

Mon: 8:00 am – 7:00 pm
Tues: 8:00 am – 5:00 pm
Wed: 8:00 am – 12:00 pm
Thurs: 8:00 am – 7:00 pm
Fri: 8:00 am – 5:00 pm
Sat: 9:00 am – 3:00 pm
Sun: 11:00 am – 2:00 pm

Contact

Phone: 614-568-7297
Fax: 740-938-4323
Email: info@libertypethospital.com