Pet Family Concerns Form

Score Each Item On a Scale of 0-2:

• 0 = I am not concerned at this time
• 1 = There is some concern
• 2 = I am concerned about this

0-4: Your concerns are minimal at this time. You may understand what lies ahead from the passing of a previous pet, or you may not want to face the inevitable loss of your pet. As difficult as it is to consider these things, now is the time to evaluate your concerns and limitations.

5-9: Your concerns are mounting. Prepare for the changes ahead by educating yourself on your pet's condition. Consult your veterinarian and ask if they can recommend reputable online sources of information.

10-16: Your concerns about the changes in your pet are valid. Remember to value your quality of life as a caregiver, too. Now is the time to build a support system around you. Veterinary guidance will help you prepare for the medical changes in your pet while counselors and other health professionals can help you with anticipatory grief.

Below are some open-ended questions that help gauge your family's time, emotional, and (when appropriate) financial budgets:

1. Have you ever been through the loss of a pet before? If so, what was your experience (good or bad, and why)?
2. What do you hope the life expectancy of your pet will be? What do you think it will be?
3. What is the ideal situation you wish for your pet's end-of-life experience? (at home, pass away in her sleep, etc.)

1. Complete the scale at different times of the day: note circadian fluctuations in wellbeing. (We find most pets tend to do better during the day and worse at night.)
2. Request multiple members of the family complete the scale: compare observations.
3. Take periodic photos of your pet: to help you remember their physical appearance.

Resources & Contact:

• AAHA/AAFP Pain Management Guidelines: www.aahanet.org/Library/PainMgmt.aspx
• Support Center: Available 7:00 am - 11:00 pm ET, every day (inc. weekends/holidays)
• Phone: (855) 933-5683 | Website: LapofLove.com