Exam

Health History

0:00 Close

Are there any other areas you want the provider to take a look at today?

Have you been recommended for surgery?

Yes No

Is that something you are planning on exploring?

Yes No

Are there any other routes you are exploring for the treatment of your condition?

What body area are we treating today?

Tell me about your condition history and how it’s affecting you.

What is your reported pain level?

Where is your pain level today?

Is your sleep affected by the pain?

Yes No

Tell me more about how your sleep is affected.

What is one of your lifestyle goals?

How is your condition affecting your ability to meet that goal?

What have you been using to manage the pain?

Have you had a steroid injection?

Yes No

Describe your experience with steroid use.

How do you feel about surgery as a recommendation?

Provider has confirmed contraindications from the welcome packet.

Yes No

Does the patient have at least 2 lifestyle goals?

Yes No

Did the patient say surgery is not how they want to be treated?

Yes No

Does the patient understand the result of inaction?

Yes No

Did the provider explain the condition and the value of starting today?

Yes No

Does the patient believe QC Kinetix is their best option?

Yes No