Pain Diagram - Front
Patient Forms: Step (7 of 10)
(Please identify areas of pain - Front of body)
   
Please select severity of pain by clicking one of the buttons and then moving your cursor over the body diagram and click the area of pain.

Once you have identified all areas of pain, click the SEND button to send this information to the doctor.
Sharp Pain:
 (red)
Dull Achy Pain:
 (blue)
Numbness:
 (green)
No Pain (reset):
 (gray)
 
If you would like to enter comments to help the doctor understand more about the pain you are having please enter them here.
 
Click the arrow button below to send the pain information. After the information is sent this window will be closed and you may continue filling out the Patient Form

 Send pain information
 
Page 7 of 10
 

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