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CONDITION ASSESSMENT TOOL

Know your symptoms? Not sure what to do next?

Find the possible conditions that are causing your pain with the Oasis Condition Assessment Tool. Our board-certified surgeons and pain management specialists will review the information you submit to assist in identifying your condition.

Where are you experiencing pain? (Choose all that apply)
- Neck
- Middle Back/Spine
- Lower Back/Spine
- Shoulders or Arms
- Hip, Buttocks, or Legs
- Joints (wrists, elbows, knees, ankles, etc.)
- Other
How long have you been experiencing pain?
- 0 to 6 months
- 6 months to 1 year
- 1 to 2 years
- 2 years or more
Describe any pain-related symptoms. (Choose all that apply)
- Stabbing, shooting, or radiating pain
- Tenderness, throbbing, or dull aching
- Numbness, tingling, or pins-and-needles sensations
- Burning or stinging
- Stiffness or reduced range of motion
- Localized swelling or global inflammation
- Muscular cramps or spasms
- Progressive weakness
- Lack of balance or coordination
- Difficulty walking, bending, sitting, or rotating the spine
- Abnormal curvature of the spine
- "Crunching" or grinding sensations in joints
- Other
Which circumstance resulted in your pain?
- Birth-related condition
- Accident or injury
- Aging or normal wear and tear
- Failed neck or back surgery
- Other
Have you undergone any of the following tests? (Choose all that apply)
- CT Scan
- MRI
- X-Ray
- EMG or Nerve Conduction Study
- Other
Have you tried any of the following treatments? (Choose all that apply)
- Self-care (rest, over-the-counter medications, ice & heat application, etc.)
- Alternative Therapy (Acupuncture, Yoga, Massage Therapy, etc.)
- Chiropractic Care
- Physical Therapy
- Pain Management (prescription-strength pain medication, cortisone injections, etc.)
- Surgical Intervention
- None
- Other
What type of insurance do you have?
- Preferred Provider Organization (PPO)
- Exclusive Provider Organization (EPO)
- Health Maintenance Organization (HMO)
- Personal Injury Protection (PIP)
- Worker's Compensation
- Medicare
- Medicaid
- Self Pay
- Other or Unknown
First Name*
First
Last Name*
Last
Email*
Phone*
Best Time to Contact You
- As soon as possible
- Morning
- Afternoon
- Evening
Additional Comments or Questions?
Name
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Phone (844) 366-8800

Bloomfield, NJ

Glen Rock, NJ

Jersey City, NJ

Brooklyn, NY

About Oasis Medical Group

Conditions We Treat

Spine Procedures

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