Feline Musculoskeletal Pain Index
Use this survey developed by NCSU-CVM to help describe your kitty's pain level.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Pain Assessment
Choose the circle that best describes your kitty's ability to perform the following activities.
Jump Up
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Jump Up to kitchen counter height in one try
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Jump Down (How well and how easily)
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Play with toys and/or chase objects
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Play and interact with other pets
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Get up from a resting position
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Lie and/or sit down
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Stretch
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Groom him/herself
*
Normal
0
1
2
3
4
Not at All
5
0 is Normal, 5 is Not at All
Total Pain Score ( 0 = No Pain, 100 = Severe Pain)
Submit Pain Score to Holistic Veterinary House Calls
Should be Empty: