Pain Management in New Jersey

Rate Your Middle Back Pain

Please rate your pain on a scale of 1 to 10. This will help us understand the intensity of your pain and guide your treatment.

Range Slider

0

1

2

3

4

5

6

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8

9

10

Mild pain, tolerable most of the time

Moderate pain, becomes unbearable at times

Severe pain, hard to bear most of the time

Excruciating pain, prevents daily activities

Radiating Leg Pain

Pain that travels from your lower back into your legs or feet may be linked to spine-related issues.

Does your pain radiate into your legs?

Please select the option that best describes your experience.

Does Your Pain Radiate into Your Legs?

Buttocks/Upper Leg

Down One Leg into Foot

Down Both Legs

No Radiating Leg Pain

The Origins of Your Pain

Understanding how your pain began helps your doctor find the best treatment. Did it start suddenly or gradually?

The Length of Your Pain

Knowing how long you’ve been in pain helps your doctor understand its progression and guide your treatment.

How long have you been in pain?

Select the option that best describes your experience.

How Long Have You Been in Pain?

Days

Weeks

Months

Years

Daily Activities

Certain movements or actions can make your pain worse. Identifying them helps your doctor understand the cause of your pain.

Daily Activities

Some activities or positions can reduce your pain and make you more comfortable. Identifying these helps your doctor find the best relief options.

What Treatments Have You Tried?

Sharing your past treatments helps your doctor choose the best approach for your recovery.

Associated Symptoms

Other symptoms often appear alongside back or neck pain. Identifying them helps your doctor understand the cause of your pain.

Do you experience any of the following symptoms?

Select all that apply.

Do You Experience Any of the Following Symptoms Associated with Your Pain?

Muscle Tightness or Stiffness

Weakness in Hand/Arm/Foot or Leg

Uneven Hips or Shoulders

None

Previous Medical Image Testing

If you’ve had tests like X-rays, MRIs, or CT scans, they can help your doctor better understand your pain. If these tests are outdated, the doctor may recommend new ones.

Understanding More About You

Your age, height, and weight help your doctor identify factors that may be related to your pain and guide your treatment.

Please Enter Your Age

Your Pain Evaluation is Being Reviewed

Thank you for completing the evaluation. We'll review your responses and contact you to discover how we can best help.

Our Team will Contact You Shortly

How would you prefer to receive your results?

How Would You Prefer to Receive Your Results?

By Phone

By Text

You’re Almost Done!

Please provide your contact details, and our care team will reach out soon to review your results and discuss the next steps for your treatment.

First Name

Phone/Mobile

Email

Best Time to Contact You

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Suffering from Pain?

Back and Neck Pain Treatment Evaluation

3 Easy Steps

Select a Problem Area

Suffering from Pain?

Back and Neck Pain Treatment Evaluation

3 Easy Steps

Select a Problem Area

schedule appointment for a Free Phone Consult

Back and Neck Pain
Treatment Evaluation

Back and Neck Pain
Treatment Evaluation

schedule appointment
for a Free Phone Consult