Pacifica Pain Management Services, Inc.

Brief Self-Evaluation

Contact us for your pain management questions & concerns

Welcome to the Brief form of our chronic pain evaluation. We will make this as "painless" as possible. This should only take about 30-45 minutes. There are three questionnaires. These should be opened, printed, filled out, and then faxed or mailed to our office.

All information received is confidential and if sent electronically is encrypted. We follow the medical guidelines of security and privacy formulated by HIPAA.

• Tell Us About Your Pain (PDF - 78.9 KB)
• Pain Diagram (PDF - 113 KB)
• Oswestry (PDF - 82.7 KB)