Patient Forms

You may receive these forms and questionnaires prior to your appointment. These help guide your treatment plan and assess your response to treatment.

These forms and patient-reported outcomes questionnaires can be completed prior to your appointment or on the day of your appointment in our clinic.

  • Visual Analog Score: Assesses pain and the location of pain
  • EQ-5D 3L: Assesses five dimensions of health (mobility, self-care, usual activities, pain/discomfort and anxiety/depression)
  • EQ VAS: Self-rated health score
  • Oswestry Disability Index (ODI): Assesses the amount of disability created by back pain
  • Neck Disability Index (NDI): Assesses the amount of disability created by neck pain
  • SRS22r: Assesses five domains of health and how they are impacted by your spine (function, pain, self-image, mental health and satisfaction with care)
  • Migraine Disability Assessment: Assesses the impact of headaches on daily life

Please answer each question with the closest response to your experience.