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FACES Permission Form

Online form

Please complete this form online, then print. Sign and fax the completed form to:

Natalie David
Rights Manager
Global Rights Department
Elsevier Ltd
PO Box 800
Oxford OX5 1DX
UK
Tel: 215-239-3804 (US) or (+44) 1865 843830 (UK)
Fax: (+44) 1865 853333 (UK)
Email: permissions@elsevier.com or healthpermissions@elsevier.com

Permission is granted for use of the Wong-Baker FACES Pain Rating Scale subject to the stipulations listed below.

Borrowing author:
Intended use of scale:
To be used/ published by:

Stipulations

  1. Full credit shall be given on each reproduced copy of Wong-Baker FACES Pain Rating Scale in the following format and using the capitalized style of FACES in the title:
    From Hockenberry MJ, Wilson D: Wong’s essentials of pediatric nursing, ed. 8, St. Louis, 2009, Mosby. Used with permission. Copyright Mosby.
  2. No changes in, additions to, or deletions from the drawings shall be made without prior written approval of the author. The exception is the use of a different coding number for each face, such as 0 to 10, using the numbers 0,2,4,6,8,10 only. The following brief word Instructions under each facial expression must accompany the scale: FACE 0: no hurt; FACE 1: hurts little bit; FACE 2: hurts little more; FACE 3: hurts even more; FACE 4: hurts whole lot; FACE 5: hurts worst. All translations must use the words from the source in Stipulation 1. Some exceptions may be granted but must be approved. The inclusion of the original, detailed instructions is optional. (See sample below).
  3. Permission shall apply only to the work specified in this correspondence. New application shall be made for subsequent editions or for other uses of the material.
  4. A copy of the page with the intended use of the FACES must be attached to this signed form.

NOTE: Due to the hundreds of requests we receive for the FACES scale, we are able to respond only to those requests that comply with the above stipulations.

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Permission granted on above terms by:

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Wong-Baker FACES Pain Rating Scale

FACES Scale 0-5 and 0-10

Brief word instructions: Point to each face using the words to describe the pain intensity. Ask the child to choose face that best describes own pain and record the appropriate number.

Original instructions: Explain to the person that each face is for a person who feels happy because he has no pain (hurt) or sad because he has some or a lot of pain. Face 0 is very happy because he doesn't hurt at all. Face 1 hurts just a little bit. Face 2 hurts a little more. Face 3 hurts even more. Face 4 hurts a whole lot. Face 5 hurts as much as you can imagine, although you don't have to be crying to feel this bad. Ask the person to choose the face that best desribes how he is feeling.

Rating scale is recommended for persons age 3 years and older.
Download FACES scale

September 2008