Start the Chronic Pain Assessment!

It only takes 2 minutes to complete!

After you complete the assessment, one of our patient coordinators will reach out via phone, text, or email to discuss your results and help you schedule an appointment if appropriate.

Your responses are completely confidential and will help guide you toward the right next step in your care.

Let’s get started!

Tell Us About Your Pain

Help us understand the basics like where you're hurting, how long it's been going on, and how it started.

Which statement best describes your current situation?

Where is your pain located? (Check all that apply)

Head

Neck

Shoulder

Abdomen/Torso

Low Back/Pelvic

Hips/Groin

Leg/Knee

Foot/Ankle

Other

How long have you experienced this pain?

What caused your pain or injury originally?

Tell Us More About Your Symptoms

The patterns of your pain, such as when it flares up, when it improves, and how it feels, can reveal important details about what's happening and how we can help.

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.

How would you describe the pain? (Check all that apply)

Sharp

Burning

Cramping

Numbness or tingling

Radiating or throbbing

Shocking (quick jolts of pain)

Other

When does your pain lessen or disappear? (Check all that apply)

In the morning after waking up

While standing or walking

While bending backward

While sitting

While lying down

While performing strenuous activity

None of the above

When is your pain at its worst? (Check all that apply)

In the morning after waking up

While standing or walking

While bending backward

While sitting

While lying down

While performing strenuous activity

Tell Us About Your Care History & Treatment Interests

Knowing what you've already tried and which treatments interest you helps us understand where you are in your healthcare journey.

Have you discussed your pain with your primary care physician?

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? (Check all that apply)

CT Scan

MRI

X-Ray

Nerve Conduction Study-EMG

Other

None of the above

What pain treatments are you interested in? (Check all that apply)

Infared Electromagnetic Therapy

Digital Electrotherapeutic Stimulation

Massage Therapy or Active Release Technique® (ART)

Manual Manipulation

Muscle Stimulation

Rehabilitation Exercises

Joint Pain Injections

Spinal Decompression

Graston technique® for IASTM (Scraping)

Kinesiotherapy

Pre/Post-Op Rehabilitation

Chiropractic Care

I'm not sure

Tell Us About Yourself

First Name

Last Name

Phone/Mobile

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Terms & Conditions

Take the 2-Minute Chronic Pain Assessment

Start the Chronic Pain Assessment!