We care about the needs of our community! 

Bialy's Wellness Foundation is tackling an exciting project that includes surveying pet owners/caretakers of pets with mobility impairments. This survey will provide us with information necessary to create and implement programs furthering our mission and serving you better.

Please complete the form below if you would like to partake in the survey.
The more data we have the more we can help! 

**Note: Your PERSONAL information will not be shared with anyone else.**

Contact (Part 1/8)
Name *
Name
Mailing Address
Mailing Address
May Bialy's Wellness Foundation contact you regarding your pet or caregiving experience? *
Pet's Information (Part 2/8)
Pet's date of birth? *
Pet's date of birth?
Best guess/approximate if unknown.
Pet's gender? *
Was your pet spayed/neutered? *
Did this pet have insurance? *
Diagnosis (Part 3/8)
Your pet's suspected or confirmed diagnosis: *
I took my pet to consult with the following specialist(s): *
Please select all that apply.
What diagnostics were performed? *
Please select all that apply.
Was surgery an option? *
Mobility (Part 4/8)
How would you describe your pet's mobility at the start of diagnosis or when you first started caring for your pet (i.e. if the pet was a foster)? *
Please select all that apply.
How did your pet's mobility change? *
Did your pet receive any of the following treatments? *
Please select all that apply.
Did your pet utilize any of the following assistive devices or supplies? *
Please select all that apply.
Incontinence (Part 5/8)
Was your pet fecal incontinent? *
Was your pet urinary incontinent? *
If urinary incontinent, did your pet struggle with urinary tract infections?
Did you have to express your pet's bladder? *
Did you have to express your pet's bowel? *
Did you do additional loads of laundry? *
If yes, approximately how many additional loads of laundry were done each week?
Medications (Part 6/8)
What medication(s) was your pet prescribed? *
In support of comfort, incontinence/bladder, mobility, neurologic function. Please select all that apply.
What supplement(s) was your pet given? *
In support of comfort, incontinence/bladder, mobility, neurologic function. Please select all that apply.
Pain and Care (Part 7/8)
Did your pet experience any of the following? *
Please select all that apply.
How often did your pet experience pain or discomfort? *
Pain or discomfort interfered with your pet's behavior. *
Pain or discomfort interfered with your pet's ability to walk or move about. *
Pain or discomfort interfered with your pet's sleep. *
Pain or discomfort interfered with your pet's normal activities. *
Perspective and Resources (Part 8/8)
There were people to confide in regarding my pet. *
Caring for my pet has interfered with my normal daily activities. *
I have enjoyed caring for my pet. *
I have been satisfied with my pet's ability to do what they enjoy doing. *
I have felt weighed down, worried, anxious, or nervous by my pet's health concerns. *
I have struggled financially because of my pet. *
I felt comfortable leaving my pet alone.
Did you go on vacation with your pet? *
I felt comfortable leaving my pet: *
Please select all that apply.
What tools, if any, did you use to help care for your pet? *
Please select all that apply.
When caring for my pet I wish I had access to: *
Please select all that apply.
Would you take on the responsibility of caring for a pet with mobilitiy impairments again? *
Please include any challenges, memorable moments, quality of life concerns, physical limitations, or stories.