This tool is not about finding a "right" answer — it's about helping you see your pet clearly on the days when love makes it hard to look. Score each category honestly, total the numbers, and use the guide to understand what you're seeing. Do this weekly, or on days that feel particularly hard or particularly good.
For each category, write the number that best reflects your pet's experience over the past few days. Use 1 = significant struggle and 5 = doing well.
| Description | Score |
|---|---|
| Refusing all food and water; shows no interest | 1 |
| Barely eating; requires significant coaxing or syringe feeding | 2 |
| Eating/drinking inconsistently; some interest but noticeably reduced | 3 |
| Eating and drinking most of the time with mild encouragement | 4 |
| Eating and drinking normally; good appetite and interest in food | 5 |
My score for Eating & Drinking: _______ Date: ___________
| Description | Score |
|---|---|
| Unable to stand, walk, or reposition; requires full assistance | 1 |
| Very limited movement; falls, stumbles, or cries when trying to move | 2 |
| Can move with difficulty; slow or unsteady but manages short distances | 3 |
| Moves reasonably well; some stiffness but gets around | 4 |
| Moves freely and comfortably; no significant limitations | 5 |
My score for Mobility: _______ Date: ___________
| Description | Score |
|---|---|
| Constant signs of pain: crying, panting, trembling, or won't settle | 1 |
| Frequent pain indicators; medication provides minimal relief | 2 |
| Pain present but manageable; some comfortable periods with medication | 3 |
| Mostly comfortable; occasional brief signs of discomfort | 4 |
| Appears comfortable and at ease; no visible pain indicators | 5 |
My score for Pain & Distress: _______ Date: ___________
| Description | Score |
|---|---|
| Consistently soiling themselves; unable to groom; skin issues developing | 1 |
| Frequent accidents; matted coat; difficulty maintaining any cleanliness | 2 |
| Occasional accidents; some grooming happens; manageable with assistance | 3 |
| Mostly maintains hygiene; rare accidents; fairly clean and comfortable | 4 |
| Clean and dignified; grooming or being groomed without distress | 5 |
My score for Hygiene & Dignity: _______ Date: ___________
| Description | Score |
|---|---|
| Withdrawn, unresponsive, or showing signs of depression or constant anxiety | 1 |
| Mostly disengaged; dull expression; rarely responds to familiar voices | 2 |
| Some moments of connection; responds occasionally to voice or touch | 3 |
| Often engaged; shows recognition; occasional joy or contentment | 4 |
| Alert, present, and visibly happy; tail wags, purrs, or seeks affection | 5 |
My score for Happiness: _______ Date: ___________
| Description | Score |
|---|---|
| No interest in surroundings, play, people, or pets; completely withdrawn | 1 |
| Minimal awareness; rarely notices activity in the room | 2 |
| Some awareness; watches the room; responds to name or familiar sounds | 3 |
| Notices things; shows interest in mild activities and short interactions | 4 |
| Curious and engaged; interested in toys, walks, or family activity | 5 |
My score for Engagement: _______ Date: ___________
Remember: A single score is just a snapshot. The trend over time matters most. If scores drop consistently over 1–2 weeks, that pattern is meaningful even when individual days look okay. Bring this worksheet to your consultation with Dr. Dixon.
Record your pet's weekly scores below. Fill in the date at the top of each column.
| Category | Week 1 ____/__ |
Week 2 ____/__ |
Week 3 ____/__ |
Week 4 ____/__ |
Week 5 ____/__ |
Week 6 ____/__ |
|---|---|---|---|---|---|---|
| Eating & Drinking | ||||||
| Mobility & Comfort | ||||||
| Pain & Distress | ||||||
| Hygiene & Dignity | ||||||
| Happiness | ||||||
| Engagement | ||||||
| TOTAL (/ 30) | ||||||
| Good / Bad Days |
Record specific symptoms, behavior changes, or things you want to share with Dr. Dixon: