Alert

Lorem ipsum
Okay
Logo

Caregiving Survey

Address
  • {name}
I agree to have Wild Hearts contact me regarding my caregiving experience.
Gender
Neutered?
Did this pet have insurance?
Your pet's suspected or confirmed diagnosis:
I took my pet to consult with the following specialist(s):
Please select all that apply.
  • Internist
  • Neurologist
  • Orthopedist
  • Primary Care Vet
  • Rehabilitation Vet
  • None
What diagnostics were performed?
Please select all that apply.
  • Bloodwork
  • CT
  • MRI
  • Surgery
  • Radiographs
  • Urinalysis
  • None
Was surgery an option?
How would you describe your pet's mobility at the start of diagnosis or when you first started caring for your pet (i.e. if the pet was a foster)?
  • No mobility issues or concerns
  • Ataxic (uncoordinated)
  • Paretic (weak)
  • Front Limb(s) Paralyzed (unable to move)
  • Hind Limb(s) Paralyzed (unable to move)
  • Front Limb Limb Loss
  • Hind Limb Limb Loss
  • Limb Deformity
How did your pet's mobility change?
  • My pet's mobility remained the same.
  • My pet's mobility improved.
  • My pet's mobility continued to deteriorate.
Did your pet receive any of the following treatments?
Please select all that apply.
  • Acupuncture
  • Assisi Loop
  • Chiropractic Care
  • Homeopathic Treatment
  • Laser Therapy
  • Massage Therapy
  • NMES (Neuromuscular Electrical Stimulation)
  • PRP Injections (Platelet Rich Plasma)
  • Shockwave Therapy
  • Surgery
  • TENS (Transcutaneous Electrical Nerve Stimulation)
  • Therapeutic Exercises
  • Therapeutic Ultrasound
  • Underwater Treadmill/Swimming
  • None
Did your pet utilize any of the following assistive devices or supplies?
Please select all that apply.
  • Belly Band/Diapers
  • Booties
  • Brace
  • Cart/Wheelchair
  • Harness with handles
  • Orthotic/Prosthetic
  • Potty Pads
  • Sling
  • Toe Grips
  • None
Was your pet fecal incontinent?
Was your pet urinary incontinent?
Was your pet prescribed any of the following medications?
In support of comfort, incontinence/bladder, mobility, neurologic function. Please select all that apply.
  • Antibiotics (Amoxicillin, Baytril, Cephalexin, Clavamox, Clindamycin, Doxycycline, Enrofloxacin, Flagyl, Metronidazole, Sulfamethoxole, Tetracycline, Tylan/Tylosin)
  • Anti-seizure (Diazepam, Felbamate, Keppra, Levetiracetam, Phenobarbital, Potassium Bromide, Valium, Zonisamide)
  • Behavior Modifiers (Acepromazine, Diazepam, Fluoxetine, Midazolam, Trazadone, Xylazine)
  • Bladder Focused (Bethanechol, Phenylpropanolamine, Prazosin, Prion)
  • NSAID/Pain Reliever (Carprofen, Deracoxib, Gabapentin, Galliprant, Firocoxib, Meloxicam, Metacam, Rimadyl)
  • Opioid Pain Reliever (Butorphanol, Codeine, Fentanyl, Meperidine, Oxycodone)
  • Steroids (Dexamethasone, Prednisone, Prednisolone)
  • None
Was your pet given any of the following supplements?
In support of comfort, incontinence/bladder, mobility, neurologic function. Please select all that apply.
  • Adequan
  • Bladder Support
  • CBD
  • Chinese Herbs
  • Fish Oil
  • Homeopathics
  • Joint Support
  • Ligament/Tendon Support
  • MYOS
  • Neurologic Support
  • Probiotics
  • Vitamin B12
  • None
Did your pet experience any of the following?
  • Behavior changes/issues
  • Difficulty breathing
  • Dragging/knuckling of feet causing wounds
  • Licking or chewing on affected area(s)
  • Loss of sensation in limb(s)
  • Muscular twitching
  • Phantom Pain
  • Pneumonia
  • Pressure sores
  • Reactivity or sensitivity to touch
  • None
How often did your pet experience pain or discomfort?
Pain or discomfort interfered with your pet's behavior.
Pain or discomfort interfered with your pet's ability to walk or move about.
Pain or discomfort interfered with your pet's sleep.
Pain or discomfort interfered with your pet's normal activities.
There were people to confide in regarding my pet.
Caring for my pet has interfered with my normal daily activities.
I have enjoyed caring for my pet.
I have been satisfied with my pet's ability to do what they enjoy doing.
I have felt weighed down, worried, anxious, or nervous by my pet's health concerns.
I have struggled financially because of my pet.
I felt comfortable leaving my pet alone.
Did you go on vacation with your pet?
I felt comfortable leaving my pet:
Please select all that apply.
  • At home with a friend/family member
  • At home with a service (pet sitter)
  • At my veterinary clinic
  • At a boarding facility
  • My pet was always with me
What tools, if any, did you use to help care for your pet?
Please select all that apply.
  • Blog
  • Books
  • Friends/Family
  • Online research
  • Support groups
  • Veterinary advice (specialists, rehabilitation)
When caring for my pet I wish I had access to:
Please select all that apply.
  • An online forum or support group where I could ask questions and share experiences regarding my pet
  • Boarding/Daycare specializing in pets with mobility impairments
  • Financial assistance to cover my pet's needs
  • More information about my pet's diagnosis
  • Specialty veterinary advice
  • Workshops or classes on caregiving techniques such as bladder expression and health, massage, range of motion
  • Other
Would you take on the responsibility of caring for a pet with mobilitiy impairments again?
If you would like to share anything else about your experience or your pet please do so!
Please include any challenges, memorable moments, quality of life concerns, physical limitations, or stories.
  • {name}

Do not submit passwords through Airtable forms. Report malicious form