Owner Name
Pets Name
Email address
1. How severe and disturbing has your pet’s disease been?
2. What was the impact of your pet’s disease on its behaviour and/or mood? (More lazy, nervous, and/or aggressive, etc)
3. How much was your pet’s sleeping patterns disturbed by the disease?
4. How much were your pet’s meals disturbed by the disease? (It has no appetite, it scratches during meals, it does not like special food,etc)
5. How much was your pet’s playing or working activities disturbed by the disease? (It is more lazy, nervous, itchy)
6. What was the impact of your pet’s disease on its relationship to you, other family members, or other pets? (Due to mood changes, presence of skin lesions,etc)
7. How much has your pet’s disease changed its usual habits? (Change in place where he is allowed to sleep, live, eat, way in which it is walked, etc)
8. How much was the pet disturbed by the administration of therapies? (Shampoos, sprays, oral medications, injections, ear medications, etc)
9. How much time did you lose for your pet’s disease? (Administration of therapies, shampooing, home cleaning, cooking, veterinary consultations, etc)
10. How much time did you lose for your pet’s disease on your tiredness? (Extra cleaning, cooking, shampooing, etc)
11. How much were your usual activities and/or those of your family disturbed by your pet’s disease? (Leisure, vacation, walks, work, hunting, etc)
12. How much impact did your pet’s disease have on your expenditure? (Cost of treatment, veterinarian, etc)
13. How much effect did your pet’s disease have on causing emotional distress (Feelings of guilt, powerlessness, sorrow, regret, anxiety, nuisance, disgust, anger, frustration, etc)
14. How much physical uneasiness/discomfort did you experience due to your pet’s disease (Offending odour, feeling of dirtiness at home, aesthetic nuisance, etc)
15. How much impact did your pet’s disease have on the relationship between family members? (Between spouses, parents and children, relatives and friends, etc)
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by KIAI Agency