Canine Brief Pain Inventory - Kalinga Park Veterinary Surgery

Canine Brief Pain Inventory

URL

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Pets Name(Required)

Owner Surname(Required)

Phone

Email(Required)

Pain Inventory

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

(0 = No Pain , 10 = Extreme Pain)

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

(0 = No Pain , 10 = Extreme Pain)

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

(0 = No Pain , 10 = Extreme Pain)

WHich number that best describes the pain as it is right now.

(0 = No Pain , 10 = Extreme Pain)

Description of function:

Pick the position or number that best describes how during the last 7 days pain has interfered with your dog's: (0 = Does not interfere , 10 = Compolete Interfers)

General Activity

(0 = Does not interfere , 10 = Compolete Interfers)

Enjoyment of Life

(0 = Does not interfere , 10 = Compolete Interfers)

Ability to Rise to Standing From Lying Down

(0 = Does not interfere , 10 = Compolete Interfers)

Ability to Walk

(0 = Does not interfere , 10 = Compolete Interfers)

Ability to Run

(0 = Does not interfere , 10 = Compolete Interfers)

Ability to Climb Stairs, Curbs, Doorsteps, etc.

(0 = Does not interfere , 10 = Compolete Interfers)

Overall Quality of Life

Fill in the oval next to the one number 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.

The Canine Brief Pain Inventory (Canine BPI; www.CanineBPI.com ) copyright is held
by Dr. Dorothy Cimino Brown

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