Author: Robert M. Stein

Animal Pain Management Center
Located at
Amherst Small Animal Hospital

2217 Kensington Avenue
Snyder, NY 14226

Client	Patient	Date

Phone: 716-839-1100
E-mail: drstein@vasg.org
www.managingpetpain.com
www.vasg.org

		No Problem / 1	A Little / 2	Quite a bit / 3	Severe / 4	Impossible / 5
1.	Walk
2.	Run
3.	Jump
4.	Turning Suddenly
5.	Getting up from lying down
6.	Lying down from standing
7.	Climbing stairs
8.	Descending stairs
9.	Squatting to urinate
10.	Squatting to defecate
11.	Stiffness in the morning
12.	Stiffness in the evening
13.	Difficulty walking on slippery floors
14.	Willingness to play voluntarily

Patient total		(70 pt max score)

Integrating Western Medications, Acupuncture, Physiotherapy and Advanced Anesthesia to improve the quality and extend the lives of our pets