You are in the best position to look for subtle changes of behaviours that indicate your pet is in pain. If your pet is showing one or more of these behaviours he/she maybe hurting. By completing this assessment, you are helping us to identify possible painful conditions.

Please check all that apply:

Vocalizing:

• Whining ○
• Howling ○
• Whimpering ○
• Yelping ○
• Groaning ○
• Grunting ○

Daily Habits:

• Decreased Appetite  ○
• Withdraws from social interaction ○
• Changes in sleeping (more or less)  ○
• Changes in drinking ○
• Lapses in house training or struggles to get into the position ○
• Seeks more affection then usual ○

Self Mutilation:

• Licking one or more areas obsessively of his/her body ○
• Biting at one or more areas of his/her body ○
• Scratching a particular part of his/her body ○

Activity Level:

• Restless, pacing ○
• Repeatedly gets up and lies down; can’t seem to get comfortable ○
• Difficulty lying down or getting up ○
• Trembling, circling or lying very still ○
• Moves stiffly or slowly after exercise or sleeping/resting ○
• Less energy or activity ○
• Reluctant to move ○
• Less playful or willing to exercise ○
• Less eager to jump on furniture or into the car ○
• Difficulty in walking or running; particularly on wood or tile floor or stairs ○

Facial Expressions:

• Grimaces or vacant stare ○
• Glazed, wide eyed or sleepy ○
• Enlarged pupils ○
• Flattened ears ○
• Pants excessively at rest ○

Self Protection:

• Protects a body part ○
• Doesn’t put weight on a leg ○
• Limps ○
• Doesn’t want or avoids being held or picked up ○

Posture:

• Hunched with hind quarters raised and front end down on the ground ○
• Lays on his/her side ○
• Walks with an arched back ○
• Nails worn unevenly or extremely long ○

Please list any other changes that are note listed above:

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