Pet Mobility Assessment Form
Evaluate your pet’s mobility and movement with this concise, easy-to-use assessment form.
Pet Name
*
Species
*
Please Select
Dog
Cat
Other
Age (years)
*
How would you rate your pet’s overall mobility?
*
1
2
3
4
5
Select the option that best describes your pet’s ability in each area:
*
Rows
No difficulty
Mild difficulty
Moderate difficulty
Severe difficulty
Unable
Rising from lying down
1
2
3
4
5
Walking across a room
6
7
8
9
10
Climbing stairs
11
12
13
14
15
Jumping onto furniture
16
17
18
19
20
Does your pet show any of the following when moving? (Select all that apply)
Limping
Stiffness
Reluctance to move
Difficulty rising
None of these
Other
How frequently does your pet have difficulty moving?
*
Never
Rarely
Sometimes
Often
Always
Is there a specific activity your pet struggles with the most?
Additional comments (optional)
Submit Assessment
Should be Empty: