Estimated Time to Complete: 5 minutes (8 questions)
Question 1 / 8
Have you been suffering from pain for more than 6 months?
Thank you. Welcome to relief.
1 of 8
What is your average level of pain?
On a scale from 1 to 10, with 1 representing minimal and 10 being most severe, rate your personal pain.
1
2
3
4
5
6
7
8
9
10
Where is your pain located?
Choose all areas that apply.
Do you feel some relief when you:
Lean on something
Bend forward
Sit down
Which of the following treatments are you currently using or have used in the past?
Choose all that apply.
Are you currently being treated by a pain management specialist?
Pain management specialists are doctors who specialize in all kinds of pain. They receive years of advanced training in pain management and focus on treating patients with severe pain.
My Name is
My Whatsapp No is
My Email Id is
My Country Name is
My age is Under 35 35-44 45-54 55-64 65 and over I'd rather not say
My gender is Male Female Non-binary I'd rather not say
What type of insurance do you have?
Here’s what you told us.
Your complaint has been recorded. Our team will contact you shortly to schedule an appointment with Dr. Pratik Israni.
Meanwhile, kindly share your medical reports with us on WhatsApp at 96196 75958.
To make any changes, simply click on the link to your answer below.
1 You have been suffering from pain for .
2 Your average level of pain is .
3 You feel your pain in your .
4 You when you lean on something, bend forward, or sit down.
5 You have tried the following treatments:
6 You are by a pain management specialist.
7 Your name is CompuBrain, Your phone no is 9512150000, Your email is dev@compubrain.in, Your country nae is India, You are 45-54 years of age and you are female.
8 You are insured by .