HELSINKI CHRONIC PAIN INDEX Step 1 of 13 7% Today’s Date:* 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 alert Alert Neither alert,Nor indifferent Indifferent Very indifferent Points 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 willingly Willingly Reluctantly Very reluctant Does not at all Points 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):* Never Hardly ever Sometimes Often Very often Points Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to walk:* Very willingly Willingly Reluctantly Very reluctant Does not at all Points Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to trot:* Very willingly Willingly Reluctantly Very reluctant Does not at all Points Check only one answer – the one that best describes your dog during the preceding week. Rate your dog’s willingness to gallop:* Very willingly Willingly Reluctantly Very reluctant Does not at all Points 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 willingly Willingly Reluctantly Very reluctant Does not at all Points 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 ease Easily Neither easily, Nor difficult With difficulty With great difficulty Points 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 ease Easily Neither easily, Nor difficult With difficulty With great difficulty Points 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:* Never Hardly ever Sometimes Often Very often/always Points 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:* Never Hardly ever Sometimes Often Very often/always Points Total chronic pain index score:
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