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Where is Your Pain?

Using your mouse, click on the body where you are experiencing pain or discomfort.

Click on as many areas as you need to in order to let us know all your areas of concern.

Radiating Leg Pain

Radiating leg pain through your legs or feet is a common symptom of a spine related problems.

Does Your Pain Radiate into your Legs?

Because your pain is lower back, choose an answer that best describes if pain radiates to your legs.

Select if Pain Radites through your leg(s)

Radiating Arm Pain

Radiating arm pain through your arms or hands is a common symptom of a spine related problems.

Does Your Pain Radiate into your Arms?

Because your pain is upper back/neck, choose an answer that best describes if pain radiates to your arms.

Select if Pain Radites through your arm(s)

Radiating Face Pain

Radiating face pain can be a symptom of a rare spinal condition.

Do you experience Severe Jabbing or Radiating Pain to Your Face?

Select if Pain Radites through your Face

Multiple Sclerosis

Along with radiating face pain, having Multiple Sclerosis most likely points to a very specific spinal condition called Trigeminal Neuralgia.

Do you have Multiple Sclerosis?

Select if you have multiple sclerosis.

Pain presents itself in different ways.

Describing your pain accurately can make it easier for your doctor to find the cause of your pain and recommend the right treatment. Please select all of the choices that help best describe your pain.

Type of Pain

From the choices below, select those that best describe your pain.

Select type of pain you experience.

The Origins of Your Pain

Understanding the origins behind your pain is very important. When did you first notice the pain? Has the pain gotten worse over time?

Pain is normally caused by trauma or degeneration (wear and tear). For example, you can twist your knee playing tennis and feel immediate pain, or you can develop pain in your shoulder from playing tennis for 8 hours a day all summer. One pain is immediate and the other pain develops gradually over time.

How Did Your Pain Start?

Select how your pain started.

Select how your pain started

The Length of Your Pain

Co-ordinating how long you have been in pain alongside the origin of the pain helps the doctor get a clear understanding of how your pain has progressed and how deeply rooted the pain is. Pain that has lasted for years has deep roots and can be approached differently then pain that has only been around for a few days or weeks.

How Long Have You Been in Pain?

From the choices below, do your best to select the one that best indicates how long you have been in pain for.

Select how long you had pain

Daily Activities

Every pain is different and determining what movements or actions initiate the feeling of pain or make the pain feel worse helps the doctor better understand the cause and source of the pain.

What Makes your Pain Worse?

From the choices below, select all of them that either initiate your pain or make your pain worse.

Select activities that trigger pain

Daily Activities

Just as some activities or motions can be harmful, some of them can actually help alleviate your pain and make you more comfortable. This to is important for the doctor to help him better understand the starting point for your relief.

What Helps to alleviate or lessen your pain?

From the choices below, select all of them that either alleviate your pain or make your pain less.

Select activities that trigger pain

Taking Steps to Live Pain Free

Some people live with pain for years and never see a doctor. Some people get injured and are at the doctor the next day. It is important to share with the doctor all your previous treatments. Sharing this will help the doctor determine a starting point for your treatment moving forward.

What Treatments Have You Had?

Select all of the treatments listed below that you have already had in the past.

Select activities that alleviate pain

Associated Pain Symptoms

Sometimes there are other symptoms present with the onset of back or neck pain.

Determining what symptoms are associated with your pain helps the doctor identify the cause of your pain.

Do you experience any of the following symptoms associated with your pain?

Please select any associated pain symptoms.

Previous Medical Image Testing

If you have already had some medical image testing done such as an XRAY, MRI or CT Scan, the doctor can use those tests to help in his diagnosis of your pain. Sometimes the test can be outdated however and the doctor may or may not require you to get new tests done.

What Medical Image Tests Have You Had?

Select all of the medical image tests that you have had done.

Select image tests you have had

Understanding More About You

The doctor benefits greatly from having a general outline of your personal stats. Age height and weight all play a significant role in helping to determine factors that may or may not be associated to your pain.

Please enter your age and approximate height and weight

Your Pain Evaluation is Being Reviewed

Thanks for taking the time to fill out the pain evaluation. Once submitted it will be reviewed and once the review is complete we will send you your results. The results will contain likely conditions and recommended next steps.

How would you prefer to receive your results?

We can either text them to you or contact you directly by phone.

Select how you want to recieve doctor's feedback

Just About Done!

We just need your basic contact info so we can get your pain evaluation results back to you as soon as the evaluation has been reviewed.

What to Expect Next

• 1. Once submitted your pain evaluation will be reviewed.

• 2. Based on the review, some likely conditions will be provided.

• 3. Based on likely conditions we will provide some recommended next steps

Enter your Name & Mobile then click submit.

By clicking next you are confirming you have read and agree to the Terms of Use of the pain evaluation.

Just About Done!

We just need your basic contact info so we can get your pain evaluation results back to you as soon as the evaluation has been reviewed.

What to Expect Next

• 1. Once submitted your pain evaluation will be reviewed.

• 2. Based on the review, some likely conditions will be provided.

• 3. Based on likely conditions we will provide some recommended next steps

Enter your Name & Mobile then click submit.

By clicking next you are confirming you have read and agree to the Terms of Use of the pain evaluation.