Tell us about your condition

What problem brings you here today?

When did it start?

What makes the pain worse?

What makes the pain better?

What diagnostic tests have you had for this problem?

What treatments have you had for this problem?

Please describe the pain

What is the course of the pain?

Family History

Tobacco Use

Illicit Drug Use

Opioid Use

Alcohol Use

General Symptoms

Neuro

Chest Symptoms

Respiratory

Digestive

Urinary

Musculoskeletal

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