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Jeffersonville 5012 1∕2 E Hwy 62
New Albany 3105 Grant Line Rd.
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Diabetes Clinical Score (Modified)
Diabetic Clinical Score
Your Name (First & Last):
*
Pet's Name:
*
Your Email:
*
Is this an Access Vet Care patient?
*
Yes
No, my pet is seen elsewhere
Your Veterinarian's Email:
*
Instructions: Please choose the category that
best
describes how your pet is
today
Drinking/Urination
- Compared to before the onset of Diabetes:
Thirst
*
NORMAL: Drinks/urinates the same amount or less
MILD: Some increase in drinking/urinating
MODERATE: Notable increase in drinking/urinating
SEVERE: Constantly seen to be drinking/urinating
Appetite
- Compared to before the onset of Cushing's:
Appetite
*
NORMAL: Appetite is the same amount or less
MILD: Finishes food more eagerly
MODERATE: Finishes food more eagerly then begs for more
SEVERE: More obsessed with food than ever
Condition
- Compared to
YOUR LAST VISIT
, is your pet's general condition (coat, muscle tone, weight):
Condition
*
NORMAL: Condition is the same
MILD: Slight UNINTENTIONAL weight loss, and/or loss of coat condition/muscle tone
MODERATE: Moderate UNINTENTIONAL weight loss, and/or poor coat condition/muscle tone
SEVERE: Substantial UNINTENTIONAL weight loss, and/or poor coat condition/muscle tone
Weight gained and/or general condition improved.
Attitude/Activity
- Compared to before the onset of Cushing's:
Behavior
*
NORMAL: Attitude/activity is the same
MILD: Not quite themselves
MODERATE: A lot quieter and less active, less running/jumping
SEVERE: Very quiet, dull and weak and/or lying about all the time
Your Pet's Diabetes Clinical Score:
If you are human, leave this field blank.
Email to My Veterinarian
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