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The Hip Health Project

Enrollment

ENROL IN THE HIP HEALTH PROJECT NOW

Enrolment Form

After completing your enrolment, we ask that you email the following information directly to us to help assess your dogs current status before commencing the project:

An image of your dog sitting
An image of your dog standing (side on view)
A short video (<10 secs) of your dog walking

"*" indicates required fields

Client Details

Name*

Mobile*

Email Address*

Address*

Regular Vet (RV)

Phone

We will email you every 2-3 months to repeat the activity level questionnaire.

Subscribe to our newsletter for updates and to keep informed. We promise not to spam you. Emails will come out every three months.

Join our closed Facebook group and be part of the Hip Health Crew.

Account Details

Username*

Please use your first and last name as your username

Password*

Enter Password Confirm Password

Dog Details

Name*

Breed*

Breed or Mixed breed (eg : Cavoodle) details*

Sex*

Male

Female

Desexed*

Yes

No

DOB or age

Below 18 months

Above 18 months

< 18 months

When did you first notice your puppy having problems with exercise?*

Aside from hip laxity, does your puppy have any other problems?*

Is your puppy on any medications?*

LOAD Questionnaire

Which legs are sore for your dog?

LF

RF

LH

RH

Background

1. How long has your pet been suffering with his/her mobility problem?

Up to 6 months

6–12 months

12–24 months

24–36 months

more than 36 months

2. Has your dog been diagnosed as suffering from any other problems in addition to his/ her orthopedic disease?

Yes

No

Please list these if you can:

3. If you can, please list any medications that your pet is currently receiving, stating when he/she received the last dose of each:

Lifestyle

1. In the last week, on average, how far has your dog exercised each day?

0–1 kilometre

1-2 kilometres

2-3 kilometres

3-4 kilometres

more than 4 kilometres

2. In the last week, on average, how many walks has your dog had each day?

0

1

2

3

4

more than 4

3. What type of exercise is this?

Always on leash

Mostly on leash

Mostly off leash

Always off leash

Working

4. Are there particular days of the week upon which your dog has significantly more exercise? (Check more than one box if necessary.)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

5. On what sort of terrain does your dog most often exercise?

On level grass

In woodland

On street

Over rough ground

6. At exercise, how is your dog handled?

Walk on leash

Walk off leash

Trot

Run freely

7. Who limits the extent to which your dog exercises?

You

Your dog

Mobility

Generally

1. How is your dog’s mobility in general?

Very good

Good

Fair

Poor

Very poor

2. How disabled is your dog by his/her lameness?

Not at all disabled

Slightly disabled

Moderately disabled

Severely disabled

Extremely disabled

3. How active is your dog?

Extremely active

Very active

Moderately active

Slightly active

Not at all active

4. What is the effect of cold, damp weather on your dog’s lameness?

No effect

Mild effect

Moderate effect

Severe effect

Extreme effect

5. To what degree does your dog show stiffness in the affected leg after a ‘lie down’?

No stiffness

Mild stiffness

Moderate stiffness

Severe stiffness

Extreme stiffness

At exercise

6. At exercise, how active is your dog?

Extremely active

Very active

Fairly active

Not very active

Not at all active

7. How interested is your dog in exercising?

Extremely interested

Very interested

Fairly interested

Not very interested

Not at all interested

8. How would you rate your dog’s ability to exercise?

Very good

Good

Fair

Poor

Very poor

9. What overall effect does exercise have on your dog’s lameness?

No effect

Mild effect

Moderate effect

Severe effect

Extreme effect

10. How often does your dog rest (stop/sit down) during exercise?

Never

Hardly ever

Occasionally

Frequently

Very frequently

11. What is the effect of cold, damp weather on your pet’s ability to exercise?

No effect

Mild effect

Moderate effect

Severe effect

Extreme effect

12. To what degree does your dog show stiffness in the affected leg after a ‘lie down’ following exercise?

No stiffness

Mild stiffness

Moderate stiffness

Severe stiffness

Extreme stiffness

13. What is the effect of your dog’s lameness on his/her ability to exercise?

No effect

Mild effect

Moderate effect

Severe effect

Extreme effect

Weight

Would you describe your dog as

Lean

Ideal

Overweight

Obese

Course Options*

Total

Coupon

Name

This field is for validation purposes and should be left unchanged.

0401 171 196
lindy@hiphealthproject.com.au

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First Name

Last Name

Email Address

Phone Number

Message

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