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Condition Check Tool

Step 1: Tell us about your pain
Where is your pain? (choose all that apply)
- Arms
- Buttocks
- Legs
- Lower Back
- Middle Back
- Neck
- Shoulders
Where is the pain strongest?
- Arms
- Buttocks
- Legs
- Lower Back
- Middle Back
- Neck
- Shoulders
How long have you been experiencing pain?
- 1 Month or less
- 1 -6 Months
- 7 -12 Months
- 1 Year or more
How would you describe your pain symptoms?
- None
- Sharp
- Burning
- Cramping
- Numbness & Tingling
- Radiating (throbbing)
- Shocking (quick jolts of pain
Are you always in pain?
- Yes, I am in constant pain that worsens depending on what activity I am doing.
- No, it comes and goes depending on what activity I'm doing or what position I'm in.
Step 2: Describe your pain for us
When is your pain at its worst?(choose all that apply)
- In the morning after waking up
- While standing or walking
- While bending backwards
- While sitting
- While lying down
- While performing strenuous activity
When does your pain feel better?
- In the morning after waking up
- While standing or walking
- While bending backwards
- While sitting
- While lying down
- While performing strenuous activity
Step 3: Tell us about your pain history
What caused your pain originally?
- Not sure
- Lifting something heavy
- Vehicle crash
- Slip or fall
- Traumatic injury
- Leaning forward
- Other
If other please explain:
Have you undergone any of the following?
- CT Scan
- MRI
- Myelogram
- Discogram
- X-Ray
- Nerve Conduction Study
- Other
- None
If other please explain:
Step 4: Get your results
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Texas Spine Care Center uses the latest spine innovations in San Antonio.

3619 Paesanos Pkwy, Suite 302 San Antonio, TX 78231

(210) 802-4662 Info@TexasSpineCare.com

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