HELSINKI CHRONIC PAIN INDEX Step 1 of 13 7% Today’s Date:* Date Format: MM slash DD slash YYYY Pet’s Name:* Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s mood:*Very alertAlertNeither alert,Nor indifferentIndifferentVery indifferentPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to participate in play:*Very willinglyWillinglyReluctantlyVery reluctantDoes not at allPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s vocalization (audible complaining, such as whining or crying out):*NeverHardly everSometimesOftenVery oftenPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to walk:*Very willinglyWillinglyReluctantlyVery reluctantDoes not at allPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to trot:*Very willinglyWillinglyReluctantlyVery reluctantDoes not at allPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to gallop:*Very willinglyWillinglyReluctantlyVery reluctantDoes not at allPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to jump (eg, into car, onto sofa. . . . .):*Very willinglyWillinglyReluctantlyVery reluctantDoes not at allPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s ease in lying down:*With great easeEasilyNeither easily, Nor difficultWith difficultyWith great difficultyPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s ease in rising from a lying position:*With great easeEasilyNeither easily, Nor difficultWith difficultyWith great difficultyPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s difficulty in movement after a long rest:*NeverHardly everSometimesOftenVery often/alwaysPoints Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s difficulty in movement after major activity or heavy exercise:*NeverHardly everSometimesOftenVery often/alwaysPoints Total chronic pain index score:
