Chronic low back pain questionnaire images 2026

1. Click ‘Get Form’ to open the chronic low back pain questionnaire in the editor.
2. Begin by filling in your personal information at the top of the form, including your age, date of birth, and occupation.
3. Indicate how long you have experienced low back pain by filling in the years, months, and weeks.
4. Answer whether this is your first episode of low back pain by selecting 'yes' or 'no'.
5. Use the provided letters to indicate the type and location of your sensations. Make sure to complete both sides of the form.
6. Proceed through each section (1-10) by circling the ONE choice that most closely describes your current situation regarding pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, traveling, and changing degree of pain.
7. Finally, add any comments you may have in the designated area and sign at the bottom before saving or sharing your completed questionnaire.

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