Initial Questionnaire

All patients are required to fill out the Pain Evaluation/Health Status Questionnaire     prior to their first clinic visit.

Our front desk staff will provide you with a private patient access password to     download the Pain Evaluation/Health Questionnaire (requires Adobe reader to view).

Please enter your password in the box below:

Why do I need to fill in questionnaires about my pain?

Chronic pain, and the way the pain is experienced, differs from one person to the next, whether there is a specific cause for it or not. This means that two patients each with chronic pain caused by the same problem do not necessarily feel the same level of pain.

The severity of your pain depends on such things as your personal pain threshold, in which way you cope with pain, whether the pain is restricting your daily activities, how it makes you feel, and how it affects your mood. This initial questionnaire we ask you to complete assess all of these factors.

The pain specialist who will be treating you will not only want to know about the physical cause of your pain, but also about other factors that may affect the severity of your pain. Such factors may make your pain feel worse, but may also make it feel less severe. Therefore please be as detailed as you can when filling out the questionnaire. The more thorough answers or responses you provide, the more supportive it will be for the physician to evaluate this information prior to your initial consultation.

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Follow-up Questionnaire

Please fill out this brief questionnaire prior to your follow-up appointment at the clinic.

Please enter your password in the box below:

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Chart and document your daily pain scale.

Please enter your password in the box below:

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