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New patient: Lameness examination
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Hond manker anamneseformulier 2023 EN
Hond manker anamneseformulier 2023 EN
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Name owner
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Name pet
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Date of birth pet
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Breed pet
What is the specific complaint of your pet?
Lameness
Not using a limb
Abnormal stance
Difficulty getting up
Abnormal movement
Cry from pain
Problems during sport
Other
in case of sport-related problems, which sport?
In case of other problem, which?
Which limb has complaints?
Left front limb
Right front limb
Left hind limb
Right hind limb
How long is the problem going on?
How did the problem start? Did you notice a (possible) cause?
What’s the degree of lameness (mild, moderate or severe)?
Does your pet sometimes walks on 3 legs? If yes, when?
How often is your pet lame (constant, sometimes, after exercise, after playing, …. )?
Is the problem stable, worsening or improving over time?
Do you have other special remarks about the gait/movement of your pet?
Does your pet has other known medical problems?
(if so, please ask the veterinarian to send the medical records of your pet to doorverwijzen@gmail.com)
Are there already examinations performed (f.e. blood examination, radiographs, scan, …) to investigate the current problem? If yes, which exams?
(if possible: ask the veterinarian to send the results of these exams to doorverwijzen@gmail.com)
Which medication or treatment was already given for this problem?
None
Rest
Anti-inflammatory medication
Cortisone
Painkiller
Splint or bandage
Surgery
Unknown
Other
In case of anti-inflammatory medication, which?
Cimalgex
Metacam
Rimadyl
Onsior
Previcox
Daxocox
Trocoxil
Other
In case of other anti-inflammatory medication, which?
Dosage anti-inflammatory medication
When was this treatment performed and for how long? Was there any effect?
General questions about your animal
What is the purpose of your pet?
Pet
Working dog
Hunting
Sport
How active is your pet ?
Hyperactive
Active
Not so active
How is your pets appetite ?
Normal
Decreased
Absent
Increased
How much does your pet drinks?
Normal
Less
Not
More
Are there other pets in the house?
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