Consultation Questionnaire | BoneVet Orthopaedics

1. Client Information

First Name

Surname

Referring Veterinarian / Clinic

2. Patient Signalment

Pet's Name

Age (Years/Months)

Weight (kg)

Species

Breed

Sex

Other pets in the household?

Dogs Cats Other None

How long have you owned them?

3. General Health & Lifestyle

Daily Diet

Pre-Injury Activity Level

Appetite Change?

Altered Thirst?

Weight Change?

Previous Health Problems / Relatives Health?

Past Surgical History?

Recent Blood Tests?

Known Allergies / Adverse Drug 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?

Is limb held up?

Is limb dragged / scuffing nails?

Currently Walking?

Yes No

Unsteady/Ataxic Gait?

Yes No

5. Treatments & Media

Current Treatments / Medications

Include injections (like Pentosan/Beransa), pain relief tablets, joint supplements. If none, write NO.

Video Submission

Short video clips of your pet walking are extremely useful for Dr. Tonzing. 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 Information

2. Patient Signalment

3. General Health & Lifestyle

4. The Primary Problem

Lameness / Limping Assessment

Neurological / Ataxia Assessment

Fracture & Trauma Assessment

5. Treatments & Media