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.


  • 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


Sign up for an account and get immediate access to all forms.

Sign Up Now!

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