Limping Triage Form

Owner's Name:

Pet's Name:

Species:

Spayed or Neutered?YesNo

Age:

Best way to contact owner:

Primary Concerns

Which leg is your pet limping on?

When did the limping first start?

How often does your pet limping?ConstantlyIntermittentlyOnly after exerciseOnly when getting up after laying down

Has your pet been able to put weight on affected leg?

When does the limping seem the worst?MorningEveningAfter exerciseAfter rest

Has your pet had any recent injuries or accidents?

Has your pet’s behavior changed?

Has your pet been more lethargic than usual?

What type of food/brand does your pet eat?

Has there been any recent changes in their diet or eating habits?

Has your pet been engaging in any strenuous activity or exercise recently? If yes, describe:

Does your pet have regular access to stairs, slippery floors or uneven surfaces?

Has your pet limped or has mobility issues in the past? If yes, how were they treated:

Is your pet currently on any medications, dosages?

Does your pet have any known allergies or chronic illnesses?

Is there anything else you would like us to know about your pets condition