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Dr. Myatt's Pain Drawing |
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| Please draw in the appropriate location of pain with the symbol that best describes the discomfort that you are presently experiencing. Be as accurate and complete as you can. Then answer the questions below. | Patient Name: Date: |
| Sharp and Stabbing =
++++++ Dull and Achy = VVVVV Pins and Needles = OOOOO Numbness = //////////// Spasm or Cramp = SSSSS Stiff or Tight or Tense = XXXXX |
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| What makes the pain better? What makes it worse? Have you ever had this pain before? If yes, when? When did the pain begin? Why did the pain begin? (If you know) |
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| How often do you have the
pain? A - Occasionally B - Half the time C - Frequently D - Constantly How intense is the pain? |
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copyright 2004 - 2007 - Dr. Myatt's Wellness
Club P.O. Box 900, Snowflake, AZ 85937 |
