Pain Awareness Questionnaire"*" indicates required fieldsClient Name* First Last Cat Name*Cat Age*Date* MM slash DD slash YYYY FELINE MUSCULOSKELETAL PAIN INDEX: Please read the following questions and think about your responses as it affects your cat. Please circle what BEST describes your cat’s ability to complete the following tasks on a scale of 0-4 0 = unable to perform task at all, 4 = able to perform task without hesitation or problems If you need to elaborate or qualify, please add short note on back of page1. The ability to get up from a resting position? 0 1 2 3 42. The ability to lie and / or sit down? 0 1 2 3 43. The ability to jump up to a low or average height ~ couch, ottoman? 0 1 2 3 44. The ability to jump up to higher heights ~ kitchen counter, beds in one attempt? 0 1 2 3 45. The ability to jump down ~ how successful and easily is it performed 0 1 2 3 46. The ability to play with toys, chase laser pointer or other objects? 0 1 2 3 47. The ability to play and interact with family members or other pets? 0 1 2 3 48. The ability to stretch? 0 1 2 3 49. The ability to groom? 0 1 2 3 4
