Canine Brief Pain Inventory Form

"*" indicates required fields

Client Information

Name*

Canine Brief Pain Inventory

Description of Pain

Rate your dog’s pain on the measures below.
0 is No Pain | 10 is Extreme Pain
0 is No Pain | 10 is Extreme Pain
0 is No Pain | 10 is Extreme Pain
0 is No Pain | 10 is Extreme Pain

Description of Function

Choose a number that best describes how pain has interfered with your dog’s function in the last 7 days. (0 meaning does not interfere, 10 meaning completely interferes)

Overall Impression

Choose the option that best describes your dog's overall quality of life over the last 7 days*
This field is for validation purposes and should be left unchanged.
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