1. Fill in the oval next to the one number that best describes the pain at its worst in the last 7 days (0 = no pain, 10 = extreme pain)
2. Fill in the oval next to the one number that best describes the pain at its least in the last 7 days (0 = no pain, 10 = extreme pain)
3. Fill in the oval next to the one number that best describes the pain at its average in the last 7 days (0 = no pain, 10 = extreme pain)
4. Fill in the oval next to the one number that best describes the pain as it is right now (0 = no pain, 10 = extreme pain)
5. Fill in the oval next to the one number that best describes how during the last 7 days pain has interfered with your dog's GENERAL ACTIVITY (0 = does not interfere, 10 = completely interferes)
6. Fill in the oval next to the one number that best describes how during the last 7 days pain has interfered with your dog's ENJOYMENT OF LIFE (0 = does not interfere, 10 = completely interferes)
7. Fill in the oval next to the one number that best describes how during the last 7 days pain has interfered with your dog's ABILITY TO RISE TO STANDING FROM LYING DOWN (0 = does not interfere, 10 = completely interferes)
8. Fill in the oval next to the one number that best describes how during the last 7 days pain has interfered with your dog's ABILITY TO WALK (0 = does not interfere, 10 = completely interferes)
9. Fill in the oval next to the one number that best describes how during the last 7 days pain has interfered with your dog's ABILITY TO RUN (0 = does not interfere, 10 = completely interferes)
10. Fill in the oval next to the one number that best describes how during the last 7 days pain has interfered with your dog's ABILITY TO CLIMB STAIRS, CURBS, DOORSTEPS, ETC (0 = does not interfere, 10 = completely interferes)
11. Fill in the oval next to the one number that best describes your dog's overall quality of life over the last 7 days
