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Spine Procedures
360 Fusion (ALIF & PLIF)
Anterior Cervical Discectomy and Fusion (ACDF)
Anterior Lumbar Interbody Fusion (ALIF)
Anterior/Posterior Cervical Discectomy
Endoscopic Foraminotomy
Endoscopic Laminectomy
Endoscopic Laminotomy
Laser Spine Surgery
Lateral Lumbar Interbody Fusion (XLIF)
Lumbar Endoscopic Discectomy
Microdiscectomy
Minimally-Invasive Spine Surgery
Posterior Lumbar Interbody Fusion
Rhizotomy
Transforaminal Lumbar Interbody Fusion (TLIF)
Vertebroplasty and Kyphoplasty
Conditions We Treat
Ankle & Foot Pain
Automobile Injury
Bone Spurs
Bursitis & Tendonitis
Bulging Disc
Cartilage Tears
Disc Degeneration
Disc Tears
Elbow Injuries
Fractures
Hand & Wrist Pain
Herniated Disc
Hip & Knee Pain
Low Back Pain
Mid-Back Pain
Nerve Damage
Osteoarthritis & Joint Pain
Personal Injury
Sciatica
Shoulder Pain
Spinal Stenosis
Spine & Neck Pain
Strains & Sprains
Workers’ Comp
Our Services
General Orthopedics
Minimally-Invasive Spine Surgery
Non-Surgical Treatments (PT, Rehab, Exercise)
Pain Management
Bursa Injections
Caudal Epidural
Discogram or Discography
Epidural Steroid Injections
Facet Joint Injections
Nerve Blocks
Radiofrequency Ablation (RFA)
Sacroiliac Joint Injections
Steroid Injections
Transforaminal Epidural Injections
Sports Medicine
Surgical Treatments
Locations
New Jersey
Clifton
Glen Rock
Union
Jersey City
Newark
New York
Brooklyn
About Us
Our Team
Patient Resources
Guided Tools
Patient Forms
Blog
Contact
Spine Procedures
360 Fusion (ALIF & PLIF)
Anterior Cervical Discectomy and Fusion (ACDF)
Anterior Lumbar Interbody Fusion (ALIF)
Anterior/Posterior Cervical Discectomy
Endoscopic Foraminotomy
Endoscopic Laminectomy
Endoscopic Laminotomy
Laser Spine Surgery
Lateral Lumbar Interbody Fusion (XLIF)
Lumbar Endoscopic Discectomy
Microdiscectomy
Minimally-Invasive Spine Surgery
Posterior Lumbar Interbody Fusion
Rhizotomy
Transforaminal Lumbar Interbody Fusion (TLIF)
Vertebroplasty and Kyphoplasty
Conditions We Treat
Ankle & Foot Pain
Automobile Injury
Bone Spurs
Bursitis & Tendonitis
Bulging Disc
Cartilage Tears
Disc Degeneration
Disc Tears
Elbow Injuries
Fractures
Hand & Wrist Pain
Herniated Disc
Hip & Knee Pain
Low Back Pain
Mid-Back Pain
Nerve Damage
Osteoarthritis & Joint Pain
Personal Injury
Sciatica
Shoulder Pain
Spinal Stenosis
Spine & Neck Pain
Strains & Sprains
Workers’ Comp
Our Services
General Orthopedics
Minimally-Invasive Spine Surgery
Non-Surgical Treatments (PT, Rehab, Exercise)
Pain Management
Bursa Injections
Caudal Epidural
Discogram or Discography
Epidural Steroid Injections
Facet Joint Injections
Nerve Blocks
Radiofrequency Ablation (RFA)
Sacroiliac Joint Injections
Steroid Injections
Transforaminal Epidural Injections
Sports Medicine
Surgical Treatments
Locations
New Jersey
Clifton
Glen Rock
Union
Jersey City
Newark
New York
Brooklyn
About Us
Our Team
Patient Resources
Guided Tools
Patient Forms
Blog
Contact
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.
Where is your pain located?
Neck
Middle Back/Spine
Lower Back/Spine
Shoulders or Arms
Hip, Buttocks, or Legs
Foot
Joints (wrists, elbows, knees, ankles, etc.)
Other
Where is your pain strongest?
Neck
Middle Back/Spine
Lower Back/Spine
Shoulders or Arms
Hip, Buttocks, or Legs
Foot
Joints (wrists, elbows, knees, ankles, etc.)
Other
How long have you experienced this pain?
1 month or less
1 - 6 months
7-12 months
1 year or more
How would you describe the pain?
Sharp
Burning
Cramping
Numbness or tingling
Radiating or throbbing
Shocking (quick jolts of pain)
Are you always in pain?
Yes, I'm in constant pain that may worsen depending on the activity I'm doing.
No, it comes and goes depending on what activity I'm doing or what position I'm in.
When is your pain at its worst?
In the morning after waking up
While standing or walking
While bending backward
While sitting
While lying down
While performing strenuous activity
When does your pain lessen or disappear?
In the morning after waking up
While standing or walking
While bending backward
While sitting
While lying down
While performing strenuous activity
What caused your pain or injury originally?
Not sure
Lifting something heavy
Vehicle crash or accident
Slip or fall
Traumatic Injury
Leaning forward
Other
Have you been diagnosed with a specific condition?
Yes, I've been diagnosed by a physician
No, I have not been diagnosed by a physician
Have you undergone any of the following?
CT Scan
MRI
Myelogram
Viscogram
X-Ray
Nerve Conduction Study
Other
None of the above
First Name
Last Name
Phone
Email
Insurance Type
PPO
HMO
LOP
PIP
Worker's Comp
Medicare
Medicaid
Self-pay
Additional Comments
START MY DIAGNOSIS
