Step 1 of 14 7% Functional Movement and Body Comfort Your details This is just so we can match your form to your client folder Name(Required) First Last Email(Required) Dog name(Required) House Movement Where does your dog LEAST LIKE to be touched?Have their been any changes over time in where and how much your dog likes to be touch? If so, please explain what has changed here. Surfaces Are there any surfaces that your dog doesn't like or prefers to avoid given the choice?e.g. grass, gravel, tiled floors, very soft surfaces, very hard surfaces, uneven surfaces etc. Sports Do you do any dog sports or activities with your dog? Please tell us more hereE.g. agility, flyball, canicross, swimming On and off furniture How often does your dog get on/off furniture? Not Allowed Allowed but doesn't Rare (Less than once a month) Occasional (1-2 times a month) 1 - 2 times per week Most days Every day Several times a day How easily do they get off/on furniture?0 - N/A1 (Hesitates/Seems to take a lot of effort)2345 (Super easy)If you've seen any changes over time in how your dog gets on and off furniture, please describe here; Stairs How often does your dog go upstairs in your house? Not Allowed Allowed but doesn't Rare (Less than once a month) Occasional (1-2 times a month) 1 - 2 times per week Most days Every day Several times a day How easily do they go up and down stairs?0 - N/A1 (Hesitates/Seems to take a lot of effort)2345 (Super easy)How fast do they go up the stairs?0 - N/A1 (Very slow and careful)2345 (Charges up as fast as possible)How fast do they go down stairs?0 - N/A1 (Very slow and careful)2345 (Races down as fast as possible)Does your dog use any other stairs? Please describee.g. 3 concrete steps in gardenHave you seen any changes over time in how your dog goes up and down stairs? If so, please describe here Car Travel Where does your dog travel in the car?E.g. E.g. front seat, back seat, boot, seatbelt attachment, crate/carrier, looseHow does your dog get in the car?E.g. jumps in, step, ramp, lifted?How does your dog get out the car?Have you seen any changes in your dogs willingness/ease of getting in/out of the car over time? Please describe hereHow does your dog travel in the car?1 (Sleeps like a log)2345 (On alert to everything) Specific Movements Lameness (limping) How often do you notice any signs of lameness (limping)?1 (Never)2345 (All the time)How long ago did you first notice the lameness (limping)?Have you noticed any changes in this over time? Please describe these as best as you can.On average, how bad is the lameness (limping)?1 (Barely noticeable)2345 (Struggles to weight-bare)Which leg(s) do you think the lameness (limping) is (tick all that apply) Right fore Left fore Right hind Left hind Unsure Is the lameness (limping) different through the day? Worse in the morning Worse in the evening Consistent all day Not sure Is the lameness (limping) worse after exercise or rest? Worse after exercise (e.g. a walk/play Worse after rest (e.g. getting up after a snooze) Not sure Is the lameness (limping) worse with anything else? Cold weather Wet weather Hot weather Other Please add any other notes on lameness here Hopping/Skipping How often do you notice your dog hopping/skipping with a back leg for one or more strides?1 (Never)2345 (All the time)Is this hopping/skipping in; (Tick all that apply) Walk Trot Canter/Gallop Is the hopping/skipping; Right hind only Left hind only Both - right more than left Both - left more than right Both - About equal Not sure Tell us more about any patterns you notice in the hopping/skippinge.g. left hind every few strides, right hind just occasionally and only in trot. Stiffness How often do you notice any signs of stiffness?1 (Never)2345 (All the time)How long ago did you notice this stiffness?Have you noticed any changes in stiffness over time? Please describe hereOn average, how bad is the stiffness?1 (Barely noticeable)2345 (Really stiff)Is the stiffness different throughout the day? Worse in morning Worse in evening Consistent throughout the day Not sure Is the stiffness worse after exercise or rest? Worse after exercise (e.g. a walk/play) Worse after rest (e.g. getting up after a snooze) About the same Not sure Is the stiffness worse with anything else? Cold weather Wet weather Hot weather Other Please add any other notes on stiffness here; Stretches How often does your dog do a 'cat' stretch (pulling middle of back up towards the ceiling) Several times a day Once or twice a day Most days Sometimes Rarely Not seen this How often does your dog do a 'downward dog' stretch (extending front legs, bum in air) Several times a day Once or twice a day Most days Sometimes Rarely Not seen this How often does your dog do a 'back leg' stretch (extending back legs out behind, often with neck stretched up) Several times a day Once or twice a day Most days Sometimes Rarely Not seen this If your dog does a back leg stretch, do they do; Both legs together Both legs idividually Only right leg Only left leg Do you notice any differences in how far each leg is stretchede.g. right back leg stretches all the way out and holds, left back leg stretches part way but quickly pulls forward?Have you noticed any changes in stretching habits over time?Please describe these as best as you can. Sits and Downs Sits Does your dog 'sit'? Yes - without being ask (i.e. by choice) Yes - Only if asked Occasionally - not always keen Used to but doesn't anymore No Please give examples of when /where you see your dog sit (without being asked)When your dog sits, are they; square (both legs tucked under equally, not leaning to one side or the other), resting on left hip, resting on right hip Mostly like this Sometimes Occasionally Rarely Never Downs When your dog lies down (could be asleep or just resting or chewing etc) do they prefer to be: stretched out flat - right side, stretched out flat - left side, on chest - hind legs extended behind, on chest - hind legs tucked underneath (sphinx), on chest, resting on left hip, on chest, resting on right hip, curled up in a tight ball, curled round in a loose shape, upside down, head resting on something First Choice Second Choice Third Choice When your dog lies down (could be asleep or just resting or chewing etc) which of these positions do they lay in::(Tick as many that apply) Stretched out flat - right side Stretched out flat - left side On chest - hind legs extended behind On chest - hind legs tucked underneath (sphinx) On chest, resting on left hip On chest, resting on right hip Curled up in a tight ball Curled round in a loose shape Upside down Head resting on something Of the above laying positions - which is your dogs favourite/which position do they lay in the most?Have you noticed any changes in how your dog sits or lies down over time? Please describe these as best as you can. Other positions and movements Have you ever seen your dog stand in a 'prayer' position (elbows on floor, bum in air - not a play bow, this is a stationary movement, usually quite still and looks uncomfortable)? Yes No Tell us more about your dogs 'prayer' position here: when, how often, if you can relate it to anything that happened etcHow often do you see your dog shake off (but NOT including when wet!) Several times a day Once or twice a day Most days Sometimes Rarely Not seen this When your dog shakes off (either because wet or for other reasons), do they… Just flat their head/ears Shake their head/ears and front legs Shake through their whole body to tip of tail Not sure Have you noticed any changes in their shake off over time? Licking, Chewing and Scratching Licking Does your dog lick themselves/beds/furniture/floors etc (other than to get food!) Yes No What/where do they lick (please be as specific as you can)How often and for how long do they lick? And at what times of day Chewing Does your dog chew or bite at themselves Yes No Where do they try to bite at or chew on their body (please be as specific as you can)How often and for how long do they chew? And at what times of day Scratching Does your dog scratch at themselves (other than an occasional quick itch!)? Yes No Where do they try to scratch on their body (please be as specific as you can)How often and for how long does your dog scratch? And at what times of dayDo you ever notice your dog's skin twitching or 'reacting' if you touch it? Or does touching your dog make them want to scratch? Please describe where you touch when this happens and how often.Have you noticed any changes in licking, chewing, scratching over time? Please describe these as best as you can. Other Behaviours and Movements Have you noticed your dog do any of the following? How Often? Walk with lowered head (below top of body) All the time Regularly Sometimes Rarely Never Scuff nails when walking All the time Regularly Sometimes Rarely Never Stumble All the time Regularly Sometimes Rarely Never Look wobbly or off balance All the time Regularly Sometimes Rarely Never Look like back end is dropping down All the time Regularly Sometimes Rarely Never Mostly want to lie down rather than stand when not moving All the time Regularly Sometimes Rarely Never Tremble /shake (whole body) All the time Regularly Sometimes Rarely Never Tremble/shake (one or more legs) All the time Regularly Sometimes Rarely Never Tremble/shake (head/neck) All the time Regularly Sometimes Rarely Never Please give more details on these here e.g. if scuffs a foot, do you think you know which one? Anything else? Is there anything else you want to tell us about your dog's mobility?And that's it! Time to submit.....
  
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