Canine Brief Pain Inventory - Kalinga Park Veterinary Surgery

Welcome to your Pain Assessment Questionnaire

Select the one number that best describes the pain at its worst in the last 7 days.
0 is none, 10 is extreme

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Select the number that best describes the pain at its least in the last 7 days (0 is none , 10 is extreme pain)

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

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Select the number that best describes the pain as it is right now

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0 = doesnt intefer , 10 = completely interfers

Fill in the oval next to the one number that best describes how during the last 7 days pain has interfered with your dog's:

General Activities

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Enjoyment of Life

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Ability to Rise to Standing From Lying Down

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Ability to Walk

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Ability to Run

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Ability to Climb Stairs, Curbs, Doorsteps, etc

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Select number that best describes your dog's overall quality of life over the last 7 days

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Fill in the captcha

Please enter any other notes you might have regarding your Pet's condition

Patient Name

Client Name

Email

Mobile Phone