Welcome Back Spinal Care Centre offers our patient form(s) online so they can be completed it in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form
This lets us know the history and current state of your health. You may include any questions, concerns or goals regarding what we can help you with.
Download & Print Form (or right click to save)
Pain Scales
This form is comprised of 4 pain scales. Circle the level of pain from 0 (no pain) to 10 (worst pain) on each scale with regards to your pain now, on average, at its best and at its worst. For multiple conditions, you may circle each scale more than once and indicate above each for which conditions it applies.
Download & Print Form (or right click to save)
Disability Questionnaires
Circle the most appropriate response (a-e) for each category. If a category does not apply, simply leave it blank. There is a questionnaire for neck and another for low back.
Download & Print Low Back Form (or right click to save)
