Veterinary Orthopedic Examination Form
Please complete all sections to accurately record the orthopedic intake and examination.
Animal Name
*
Species
*
Please Select
Dog
Cat
Horse
Other
Breed
Owner Name
*
Presenting Complaint / Reason for Visit
*
Onset and Duration of Problem
*
Please Select
Acute (within 48 hours)
Subacute (2-7 days)
Chronic (over 1 week)
Affected Limb(s)
*
Left Forelimb
Right Forelimb
Left Hindlimb
Right Hindlimb
Other
Gait Assessment
*
Please Select
Normal
Mild Lameness
Moderate Lameness
Severe Lameness
Non-weight bearing
Pain Level (on palpation/manipulation)
*
Please Select
None
Mild
Moderate
Severe
Exam Findings / Diagnosis / Recommendations
*
Submit Examination
Should be Empty: