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Quality of Life Assessment

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About Us
Services
FAQ & Pricing
Contact Us
Intake Form
- Service & Remembrance Form
Quality of Life Assessment

Contact Us

Quality of Life Assessment

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Quality of Life Assessment

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Scoring

No = 1 | Sometimes = 2 | Yes = 3

Date *

Pet's Name *

Mobility & Comfort

My pet can move around and change positions comfortably. *

No
Sometimes
Yes

My pet rests calmly without labored breathing. *

No
Sometimes
Yes

My pet appears relaxed, not anxious or restless. *

No
Sometimes
Yes

My pet can get up, lie down, and change position on their own. *

No
Sometimes
Yes

Mobility & Comfort Total:

Connection & Interaction

My pet recognizes family or familiar voices. *

No
Sometimes
Yes

My pet seeks comfort or closeness when offered. *

No
Sometimes
Yes

My pet's personality and "spirit" feel present. *

No
Sometimes
Yes

My pet still finds comfort in familiar routines and surroundings. *

No
Sometimes
Yes

Connection & Interaction Total:

Appetite & Hydration

My pet eats willingly and with interest. *

No
Sometimes
Yes

My pet drinks enough water on their own. *

No
Sometimes
Yes

My pet's weight and intake feel stable. *

No
Sometimes
Yes

My pet shows interest in food or treats even if appetite varies. *

No
Sometimes
Yes

Appetite & Hydration Total:

Elimination & Hygiene

My pet urinates and defecates comfortably without distress. *

No
Sometimes
Yes

My pet stays clean and dry; hygiene is manageable. *

No
Sometimes
Yes

My pet's skin and coat remain clean and healthy. *

No
Sometimes
Yes

My pet can maintain normal elimination habits with dignity. *

No
Sometimes
Yes

Elimination & Hygiene Total:

Pain & Physical Ease

My pet shows no obvious pain (limping/stiffness). *

No
Sometimes
Yes

My pet tolerates touch and gentle handling. *

No
Sometimes
Yes

My pet rests without signs of discomfort. *

No
Sometimes
Yes

My pet can easily perform everyday tasks. *

No
Sometimes
Yes

Pain & Physical Ease Total:

Time & Daily Rhythm

Good days outnumber bad days. *

No
Sometimes
Yes

My pet sleeps peacefully through the night. *

No
Sometimes
Yes

Medications are manageable and effective. *

No
Sometimes
Yes

My pet's daily routine feels calm and predictable. *

No
Sometimes
Yes

Time & Daily Rhythm Total:

Energy & Engagement

My pet shows interest in favorite people or activities. *

No
Sometimes
Yes

My pet has calm, content moments during the day. *

No
Sometimes
Yes

My pet seems happy or at peace more often than not. *

No
Sometimes
Yes

My pet still enjoys moments of curiosity or joy. *

No
Sometimes
Yes

Energy & Engagement Total:

Caregiver Reflection (Self)

I feel able to meet my pet's needs today. *

No
Sometimes
Yes

I have emotional support and am coping. *

No
Sometimes
Yes

I believe my pet is comfortable most of the time today. *

No
Sometimes
Yes

I feel at peace with the care I can provide my pet right now. *

No
Sometimes
Yes

Caregiver Reflection (Self) Total:

Mobility routines personality

Total Points:

24 – 48 = Poor quality of life (may be time to discuss next steps)
49 – 72 = Fair quality of life (monitor closely for negative changes)
73 – 96 = Good quality of life (no need for change at this time)

* This assessment is a reflection guide, not a final answer. Every pet’s journey is unique – some pets with chronic illness or injury may still score well while quietly suffering. Trust both your own intuition and your veterinarian’s expertise when considering next steps. We will be here to support you along the way.

Send to Myself/Someone Else *