Consultation Questionnaire | BoneVet Orthopaedics

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Please complete all required fields highlighted in red below.

1. Client & Vet Information

First Name *

Surname *

Email *

Regular / Primary Vet Clinic *

Referring Clinic (If different)

2. Patient Signalment

Pet's Name *

Age (Years/Months) *

Weight (kg) *

Species *

Breed *

Sex *

How long have you had your pet? *

Other pets in the household? *

Dog/s Cat/s Other None

3. General Health & Lifestyle

Daily Diet *

Pre-Injury Activity Level *

Current Activity Level *

Appetite Change? *

Altered Thirst? *

Weight Change? *

Previous Health Problems *

Health of Parents / Relatives *

Past Surgical History *

Recent Blood Tests? *

Known Allergies / Adverse Reactions *

4. The Primary Problem

What option BEST describes the current problem? *

Describe the problem in your own words *

When did it begin? *

Since onset, has it: *

If deteriorated, over what timeframe?

Is the problem constant or intermittent? *

Are they expressing pain (vocalising, crying)? *

Limbs Affected? *

Did one side/limb show signs first? *

Is limb held up? *

Is limb dragged / scuffing nails? *

Currently Walking? *

Yes No

Unsteady/Ataxic Gait? *

Walks / staggers in a similar way to a person in a "drunken" state.

Yes No

5. Treatments & Media

Current Treatments / Medications *

Include injections (like Pentosan/Beransa), pain relief tablets, joint supplements. If none, write "None".

Video Submission *

Short video clips of your pet walking are extremely useful. You can upload these via our Dropbox portal after submitting this form.

Video has been uploaded via Dropbox Video will be uploaded soon No video will be submitted

Additional Information / Comments

Clinical History Questionnaire

1. Client & Vet Information

2. Patient Signalment

3. General Health & Lifestyle

4. The Primary Problem

Lameness / Limping Assessment

Neurological / Ataxia Assessment

Fracture & Trauma Assessment

5. Treatments & Media