It is important that when the Pain Services get a referral, we are able to identify who will benefit most from our interventions. At the present time we use 2 different types of questionnaire. 

At this time we are using paper based questionnaires but in the near future we will be using a combination of paper and web based forms to assist with ease of completion. 

The initial referral

This asks the patient to complete a brief series of questions asking about their pain, how they describe their pain and aspects of current management.  Importantly it also gives them the opportunity to write down in their own words how their pain condition affects them. It is really important for the Pain Services and also the patient that this is completed.  We think its important that people with pain take control and actively manage their issues.  This even goes for taking part in our questionnaires.  

If these are not returned, we will assume that the patient is unwilling to take an active role in their management.  As such we will also have difficulty in creating any meaningful change.  However its important that if the reason for non return is due to difficulty in comprehension or other factor, patients are encouraged to contact the PMS by phone and discuss. 

IF IN DOUBT GIVE OUR OFFICE A PHONE CALL TO DISCUSS ANY ISSUES AS WE REALLY WANT TO HELP!

This first questionnaire will take around 10 minutes to complete.

Triage Referral Questionnaire (PDF)

The first appointment

A more comprehensive 7 page form is required to be completed.  This is invaluable as it gives an overview of just how much your pain condition affects your life including affects on activity, the way we think, the way we interact with other people and how we cope.

This will take 30-45 minutes to complete.