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4787 E Camp Lowell Dr, Tucson, AZ 85712
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Saturday Appointment
Saturday Appointment
Wesley
2016-09-30T12:33:49-07:00
Saturday Appointment
We will do our best to accommodate your request in a timely manner. Appointments are scheduled on a first come, first served basis for select Saturdays.
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How long have you had your pain?
Where do you feel the pain?
Is your pain in one spot or spread out?
How does the pain feel and how severe is it?
Is your pain constant or does it come and go?
What activities make your pain worse or improve it?
How does your pain limit what you can do?
How often and for how long does the pain occur?
Is there anything that triggers the pain?
Current Pain level
0 - No Pain
1
2 - Mild Pain
3
4 - Discomforting
5
6 - Distressing
7
8 - Intense
9
10 - Excruciating
Please check all words that describe how your pain feels.
Aching
Constant
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Fearful
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Heavy
Hot or burning
Punishing/Cruel
Sharp
Shooting
Sickening
Splitting
Stabbing
Tender
Throbbing
Tiring or exhausting
Please check all Activities of Daily Living (ADLs) with which you are having difficulty.
Bathing
Climbing Stairs
Cooking
Doing laundry
Dressing
Driving
Eating
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Hand writing / typing
House work
Managing finances
Managing medications
Oral care
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