Pain Questionnaire

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

Click to enlarge this image of the form running on iPad:



  • Optimized for iPads and Windows 8 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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Connect your people with robust mobile forms for iOS, Android and Windows 8.1