Medical Assessment

Dear patient, please take a look on this Mediacal Assessment form, fill all the questions as accurate as possible and send it to us.
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On the following interactive figure, mark your pain. First please select the type of pain and then click on a character and place the marker, where you feel the pain. You can use as many types of pain as needed and mark several areas of body.
panak frontpanak back
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On the number line 0-10 mark the average intensity (power) of the pain experienced last week
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Please specify how long the pain lasts
Duration of severe pain
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Duration of slight pain
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EuroPainClinics Facial Pain
Facial
Pain
Relief
EuroPainClinics Back Pain
Back
Pain
Relief
EuroPainClinics Pelvic Pain
Pelvic
Pain
Relief
EuroPainClinics Joint Pain
Joint
Pain
Relief
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