We care about the needs of our community! 

Bialy's Wellness Foundation is tackling an exciting project that includes surveying pet owners/caretakers of special needs pets (focusing on mobility issues) to provide us with the following information:

1. How to best focus our mission to create and implement programs within our scope to serve you better.

2. Collect data for grant writing purposes.

3. Create a community to connect pet owners/caretakers of special needs pets.

4. Interview/highlight cases submitted. 

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 information will not be shared with anyone else.**

Contact
Name *
Name
Address
Address
Pet's Information
Pet's date of birth? *
Pet's date of birth?
Best guess/approximate if unknown.
Pet's gender? *
Is your pet spayed/neutered? *
Did this pet have insurance? *
Diagnosis
Your pet's suspected or confirmed diagnosis: *
What diagnostics were performed? *
Please select all that apply.
Was a surgical consult performed? *
Was surgery an option? *
Not an option or not needed? Poor prognosis? Cost (too expensive)? Quality of life?
Was a veterinary rehabilitation consult performed? *
Mobility
How would you describe your pet's mobility? *
Check all that apply.
Please describe before and after if pertinent and note if your pet is ambulating normally, paretic, ataxic, or paralyzed.
Did your pet utilize any of the following assistive devices or supplies? *
Please check all that apply.
Incontinence
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? *
Medications
Pain
How often did your pet experience pain or discomfort? *
When your pet experienced pain or discomfort, how long did it usually last? *
Did your pet experience any of the following? *
Please check all that apply.
Pain or discomfort interfered with your pet's: *
Pain or discomfort interfered with your pet's:
Behavior?
Ability to walk or move about?
Sleep?
Normal activities?
Care
Did your pet develop pressure sores? *
Please provide information on efficacy of treatment.
Did your pet develop any behavior issues? *
At any point did your pet develop pneumonia? *
Perspective and Resources
I am happy with my personal life while caring for my pet. *
I feel there were people I am close to or able 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 am satisfied with my pet's ability to do what they enjoy doing. *
I have been left out and socially inactive because of my commitment to my pet (ie vacationing, visiting family and friends etc) *
I have been worried, nervous or anxious about my pet's health. *
I have felt weighed down by my pet's health concerns. *
I am struggling financially because of my pet. *
Please include any challenges, memorable moments, quality of life concerns, physical limitations, or stories.
Were you comfortable leaving your pet? Did you go on vacation? Did you get enough time to care for yourself/family?
What tools, if any, did you use to help care for your pet? *
Please check all that apply.
Please note if there were resources that were helpful or tools you wish you had to help your pet. What was/is missing?
Did you have a network or community of people that you could talk with about your pet? *
Would you take on the responsibility of caring for a special needs pet again? *