Owner Questionnaire – White Rock Veterinary Hospital in Pflugerville, Texas

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Cushing's Questionnaire Form

Info about the last 4 weeks

Pl= Possible illness- If answer 3 or more answers given then dog classified as unwell.
Name
First Last
Drinking. Do you think your dog has drank:*
- Less than normal: PI
- Normal: 1
- More than normal (for example 1-2 times normal): 3
- Very much more than normal: 4
Urinating. Do you think that the volume or frequency of urination is:*
- Less than normal: PI
- Normal: 1
- More than normal (for example 1-2 times normal): 3
- Very much more than normal: 4
Appetite. Would you describe your dog's appetite as:*
- Very poor (not eating at all or hardly eating): PI
- Poor (does eat some food but requires encouragement): PI
- Normal: 1
- Increased (eats all food quickly and will look for more): 3
- Greatly increased (seems ravenously hungry all the time): 4
Vomiting and Diarrhea. How often has your dog been experiencing vomit or diarrhea?*
- Never had vomit or diarrhea: 0
- Has had vomit or diarrhea once: 0
- Has had vomit or diarrhea more than once but not every day: PI
- Has had vomit or diarrhea everyday: PI
Exercise. How active is your dog?*
- Lays in one place nearly all the time: 4/PI
- Goes for walks and will also play on occasion: 3
- Very active, happy to run off the lead but does get tired: 2
- I cannot tire my dog out!: 1
Skin and Coat. How would you describe your dog's coat and skin condition?*
- Very poor (thin coat, bald patches, very dull): 4
- Poor (slightly thin coat, hairs dull): 3
- Reasonable (no bald patches, slightly dull): 2
- Very good (thick coat, shiny, no dandruff): 1
Other problems. Does your dog have any of the following?*
- Trembling/shaking muscle twitches more than once a week: PI
- Persistent panting even at rest: 3
- Pain (anywhere): PI
- Difficulty moving: PI
- Mental depression: PI
- None of the above
General. How do you feel your dog enjoys life?*
- Miserable more of the time: PI
- Has more bad days than good days: 0
- Happy most of the time, occasional bad days: 0
- Happy all of the time: 0
Overall how good do you feel your dog's current treatment for Cushing's is?*
- My dog has more critical signs than before treatment: 5/PI
- There is no difference now than before treatment: 4
- There is some improvement since starting treatment: 3
- My dog is nearly back to their normal self: 2
- If I did not know, I would think there was nothing wrong with my dog now: 1

Get In Touch With Us

Contact Us Book An Appointment

Location

2509 Pecan St. W
Pflugerville, Texas, 78660

Contact Us

Phone: (512) 670-5400
Email: info@whiterockvet.com

Hours

Mon – Fri 7am – 6pm
Sat 8am – 12pm
Sun Closed

Emergencies

For emergencies, we recommend:

Central Texas Veterinary Specialty & Emergency Hospital.

Location: 301 Chisholm Trail Round Rock, Texas 78681

Phone: 512-892-9038

For small mammal emergencies, we recommend that you call the location before your arrival.

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Home
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Pet Health
Links
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