Canine Brief Pain Inventory

Canine Brief Pain Inventory

Pets Name(Required)

Owner Surname(Required)

Phone(Required)

Email(Required)

Pain Inventory

Select the number that reflects your dog's pain over the last 7 days:

Which number best describes the pain at its worst in the last 7 days.

(0 = No Pain , 10 = Extreme Pain)

Which number best describes the pain at its least in the last 7 days

(0 = No Pain , 10 = Extreme Pain)

Which number best describes the pain at its average in the last 7 days.

(0 = No Pain , 10 = Extreme Pain)

Which number best describes the pain as it is right now.

(0 = No Pain , 10 = Extreme Pain)

Description of function:

Select the number that reflects how during the last 7 days pain has interfered with your dog's:

General Activity

(0 = No Interference, 10 = High Interference)

Enjoyment of Life

(0 = No Interference, 10 = High Interference)

Ability to Move From Lying Down to Standing

(0 = No Interference, 10 = High Interference)

Ability to Walk

(0 = No Interference, 10 = High Interference)

Ability to Run

(0 = No Interference, 10 = High Interference)

Ability to Climb Stairs, Kerbs, Doorsteps

(0 = No Interference, 10 = High Interference)

Overall Quality of Life

Check one option that best describes your dog's overall quality of life over the last 7 days.

Overall Impression(Required)

Calculated Pain Score

Dont change this value it is calculated from previous selections.