MyVet Home Veterinary Service

drsandra@myvetvancouver.ca
North Vancouver, BC V7R4J3

(604)786-1641

myvetvancouver.ca

     

   

Please take a moment to help us evaluate your pet's level of pain or comfort, as well as his/her level of function.  Please provide us your own impression by filling in the form below and submit when you're done.  Thank you!  

     

        

The Canine Brief Pain Inventory copyright is held by Dr. Dorothy Cimino Brown at the University of Pennsylvania (2006).

Canine Brief Pain Inventory

Your E-Mail Address (required) :
Your Pet's Name (required)
First Name (required)
Last Name (required)
Check one box next to the number that best describes your dog's pain at its WORST in the past 7 days (required)
(Describing your dog's pain)
0 no pain
1
2
3
4
5
6
7
8
9
10 extreme pain
Check one box next to the number that best describes your dog's pain at it's LEAST in the past 7days (required)
0 no pain
1
2
3
4
5
6
7
8
9
10 extreme pain
Check one box next to the number that best describes the pain at AVERAGE in the last 7 days (required)
0 no pain
1
2
3
4
5
6
7
8
9
10 extreme pain
Check one box next to the number that best describes the pain as it is RIGHT NOW (required)
0 no pain
1
2
3
4
5
6
7
8
9
10 extreme pain
GENERAL ACTIVITY: Check the box which best describes how PAIN HAS INTERFERED in the past 7 days (required)
(Describing your dog's level of function)
0 does not interfere
1
2
3
4
5
6
7
8
9
10 completely interferes
ENJOYMENT OF LIFE: Check the box which best describes how PAIN HAS INTERFERED in the past 7 days (required)
0 does not interfere
1
2
3
4
5
6
7
8
9
10 completely interferes
ABILITY TO RISE TO STANDING: Check the box which describes how PAIN HAS INTERFERED in the past 7days (required)
0 does not interfere
1
2
3
4
5
6
7
8
9
10 completely interferes
ABILITY TO WALK: Check the box which describes how PAIN HAS INTERFERED in the past 7days (required)
0 does not interfere
1
2
3
4
5
6
7
8
9
10 completely interferes
ABILITY TO RUN: Check the box which describes how PAIN HAS INTERFERED in the past 7days (required)
0 does not interfere
1
2
3
4
5
6
7
8
9
10 completely interferes
ABILITY TO CLIMB STAIRS, CURBS: Check the box which describes how PAIN HAS INTERFERED in past 7days (required)
0 does not interfere
1
2
3
4
5
6
7
8
9
10 completely interferes
Check the box next to the word that describes your dog's overall quality of life in the last 7 days (required)
Poor
Fair
Good
Very good
Excellent

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