Pain Assessment Quiz

What is the level of pain you are experiencing? (10 being most severe)

Where is the source of your pain? (Check all that apply)

How did the pain begin? (Check all that apply)

What type of doctors have you seen for your pain? (Check all that apply)

What medications or treatment are you receiving for your pain? (Check all that apply)

Have you had any of the following treatments/procedures? (Check all that apply)

Check any of the following test you have had for this condition (Check all that apply)

Have you had any surgery related to your existing pain or any prior pain condition?

Do you have any additional information about your pain you want us to know or any questions about your treatment options we can help answer?

Do you have car and/or health insurance?