Dog Quality of Life Scale: Scoring the Seven Things Vets Look At
Last reviewed: August 2026
There is no test that tells you it is time. What there is instead is a way of breaking the question into parts small enough to answer honestly, one at a time.
The scale below is the HHHHHMM scale, developed by Dr Alice Villalobos, a veterinary oncologist. Vets use it with families making this decision. It scores seven things from 0 to 10, and the total gives you something steadier than a feeling you keep second-guessing.
It is not a verdict. It is a way of seeing the week your dog is actually having, rather than the one you remember from a year ago.
Score your dog
Seven criteria, scored 0 to 10, where 10 is best. Nothing here is saved or sent anywhere — it runs in your browser and disappears when you close the tab.
Is pain controlled, and is breathing comfortable? Breathing comes first — nothing else matters if it is laboured.
Are they eating enough, without being coaxed, syringe-fed or bribed?
Are they drinking enough, or do they need subcutaneous fluids to stay level?
Can they stay clean, and move away from soiling?
Do they still respond to you, to their name, to the things they used to want?
Can they get up unaided, and get outside to toilet? Have they fallen recently?
Over the last two weeks, count them. Not the best day — the ratio.
A total of 35 or below suggests the balance has tipped, and that this is worth discussing with your vet rather than sitting with alone.
This is a discussion tool, not a threshold or a decision. Score it again in a few days without looking back at this number — two readings show you a direction, which is more useful than any single total.
What the number cannot tell you
The scale does not know your dog is frightened of the car. It does not know whether you can afford another month of medication, or lift a 40kg dog at 3am, or take the time off work. Those are real inputs and no assessment includes them.
It also cannot see what is coming. A dog scoring 40 with a rising creatinine is on a different path from one scoring 40 after surgery. Lymphoma, congestive heart failure and liver disease each have their own trajectory, and that is what your vet adds to the number.
Signs that mean today, not this week
Call a vet now, whatever the score says:
- • Laboured breathing, or breathing with the neck extended and elbows held out
- • Collapse, or an inability to stand
- • Uncontrolled pain — crying, panting, unable to settle
- • Seizures that repeat or do not stop
- • Pale or white gums
- • A distended, hard abdomen
Sudden lethargy in a dog already scoring low is worth a same-day call rather than waiting to see.
Where bloodwork fits
Some of the scale is visible from the sofa. Some of it is not.
Kidney values, weight trend and appetite markers put a number on the slope your dog is on — which is the one thing the scale cannot see. If panels have been run over the last year, the trend across them is usually more informative than any single result. The BUN:creatinine ratio and senior screening panels are usually where a decline shows first.
If you have those results and they are hard to read, VetLens will explain what changed and how quickly.
Read my dog's resultsTalking to your vet
Bring the seven scores and the dates you took them. Then ask directly:
- • What is the realistic trajectory over the next month?
- • What are we still treating, and what are we only managing?
- • If this were your dog, what would you be weighing?
Most vets will answer that last one honestly if you ask it plainly. It is often the most useful thing in the conversation.
If you are working through this for a cat as well, the cat version of this scale uses the same seven criteria, with the mobility and grooming questions adjusted for how cats show decline.
Related Reading
Senior Dog Health Screening
What a senior panel checks, and how often it is worth running
Creatinine Levels in Dogs
Reading kidney values, and what a rising trend means
Lymphoma in Dogs
Staging, treatment options and what to expect
Congestive Heart Failure in Dogs
Progression, and the signs that mean a same-day call
Liver Disease in Dogs
What the enzymes show and how the picture changes over time
Pale Gums in Dogs
One of the signs that means an emergency vet, not a wait