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My Pain Questionnaire

  • How it works.
    Use the pain questionnaire below to describe how your pain feels. You can select as many boxes as you wish to describe your pain. This questionnaire will assist your doctor in making the right diagnosis for you. After you have completed the 'my pain questionnaire', you can print out or send yourself your individual summary per email.

    All data which you actively provide in this section will be automatically deleted at the end of your internet session.

    The my pain questionnaire is also available in PDF format

    Download PDF

Please note: The information on this website cannot replace a patient consulting a healthcare professional. Only a healthcare professional can decide which diagnostic procedures and treatment options are best for each individual patient.