Pain Questionnaire

By 2gion 2 girls 1 cup

Patients of massage, physical therapy, or any clinic health practice can identify and characterize their pain symptoms on an iPad or Android tablet.

Features:

  • Optimized for iPads and Android tablets
  • Draw symptoms on a human body diagram
  • Evaluate pain on a 0-5 scale with facial cues
  • Describe the level of disability with a single button tap
  • Capture a signature
  • Email as an attachment optimized for printing

 

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Here are two more views to see the form (click to make them larger):

 

Connect your people with mobile forms for iPad, iPhone, and Android tablets and smartphones