HCPI form - Sea Legs Integrative Veterinary Health

Patient Name

Owner Last Name

Rate your pet's attitude

Very Alert

Alert

Neither alert nor indifferent

Indifferent

Very Indifferent

Rate your pet's willingness to play

Very willing

Willing

Reluctant

Very reluctant

Won't play at all

Rate your pet's vocalization:

Audible complaining, such as whining or crying out

Never

Hardly ever

Sometimes

Often

Very Often

Rate your pet's willingness to walk

Very willing

Willing

Reluctant

Very reluctant

Won't walk at all

Rate your pet's willingness to trot (or jog)

Very willing

Willing

Reluctant

Very reluctant

Won't run at all

Rate your pet's willingness to run

Very willing

Willing

Reluctant

Very reluctant

Won't run at all

Rate your pet's willingness to jump

into the car, on to the sofa

Very willing

Willing

Reluctant

Very reluctant

Won't jump at all

Rate your pet's ease lying down

With great ease

easily

neither easy nor difficult

with difficulty

With great difficult

Rate your pet's ease rising from a lying position

With great ease

easily

neither easy nor difficult

with difficulty

With great difficult

Rate your pet's ease of movement after a long rest

Never difficult

Hardly Difficult

Sometimes difficult

Often difficult

Very often/always difficult

Rate your pet's ease of movement after heavy exercise

Never difficult

Hardly Difficult

Sometimes difficult

Often difficult

Very often/always difficult

HCPI Score *