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PAIN ASSESSMENT TOOL

A preliminary diagnosis is a few keystrokes away. Our surgeons and pain management specialists will use the info you enter to assist you in finding effective treatment options.

STEP 1:

Tell Us About Your Pain and Symptoms
Neck

Spine

Hip

Ankle & Foot

Hands & Wrist

Elbow

Back

Knee
Where is the pain strongest?
How long have you been experiencing pain?
- 1 Month or less
- 1 - 6 Months
- 7 - 12 Months
- 1 Year or more
Have you been diagnosed with a specific condition?
- Yes, I have been diagnosed by a physician
- No, I have not been diagnosed by a physician
CONTINUE TO STEP 2
STEP 2:

Describe Your Pain For Us
- None
- Sharp
- Burning
- Cramping
- Numbness & tingling
- Radiating (throbbing)
- Shocking (quick jolts of pain)
Are you always in pain?
- Yes, I am in constant pain that worsens depending on what activity I am doing.
- No, it comes and goes depending on what activity I'm doing or what position I'm in.
BACK CONTINUE TO STEP 3
STEP 3:

Tell us more about your symptoms
When is your pain at its worst? Choose all that apply.
- In the morning after waking up
- While standing or walking
- While bending backwards
- While sitting
- While lying down
- While performing strenuous activity
When does your pain feel better?
- In the morning after waking up
- While standing or walking
- While bending backwards
- While sitting
- While lying down
- While performing strenuous activity
What caused your pain originally?
- Not sure
- Lifting something heavy
- Vehicle crash
- Slip or fall
- Traumatic injury
- Leaning forward
- Other
BACK CONTINUE TO STEP 4
STEP 4:

Tell Us About Your Past Treatment
Have you undergone any of the following?
- CT Scan
- MRI
- Myelogram
- Viscogram
- X-Ray
- Nerve Conduction Study
- Other
- None
BACK CONTINUE TO STEP 5
STEP 5:

Get Your Results
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Spine Procedures & Surgeries
Conditions We Treat
Medical Team
Contact Us
Privacy Policy
Free MRI Review

LOCATIONS

East Orange
Glen Rock
Jersey City
Newark
Randolph
Union
Trenton
Brooklyn

FOLLOW US

REQUEST A FREE CONSULTATION

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