Canine Brief Pain Inventory Canine Brief Pain Inventory Your Name* First Last Your Email* Today's Date* MM slash DD slash YYYY Description of pain:*Rate your dog's pain:Select the number that best describes the pain at its worst in the last 7days.* 0 1 2 3 4 5 6 7 8 9 10 10 – Extreme painSelect the number that best describes the pain at its least in the last 7 days* 0 1 2 3 4 5 6 7 8 9 10 10 – Extreme painSelect the number that best describes the pain at its average in the last 7 days.* 0 1 2 3 4 5 6 7 8 9 10 10 – Extreme painSelect the number that best describes the pain as it is right now.* 0 1 2 3 4 5 6 7 8 9 10 10 – Extreme painDescription of function:Select the number that best describes how during the last 7 days pain has interfered with your dog’s:General Activity* 0 1 2 3 4 5 6 7 8 9 10 0 – Does not interfere,10 – Completely interferesEnjoyment of Life* 0 1 2 3 4 5 6 7 8 9 10 0 – Does not interfere,10 – Completely interferesAbility to Rise to Standing From Lying Down* 0 1 2 3 4 5 6 7 8 9 10 0 – Does not interfere,10 – Completely interferesAbility to Walk* 0 1 2 3 4 5 6 7 8 9 10 0 – Does not interfere,10 – Completely interferesAbility to Run* 0 1 2 3 4 5 6 7 8 9 10 0 – Does not interfere,10 – Completely interferesAbility to Climb Stairs, Curbs, Doorsteps, etc.* 0 1 2 3 4 5 6 7 8 9 10 0 – Does not interfere,10 – Completely interferesOverall impression:Select the number that best describes your dog's overall quality of life over the last 7 days.* Poor Fair Good Very Good Excellent CAPTCHA Δ
