Get Az Apex Pain Specialists Follow-up Patient Medical History Intake Form 2010-2025

Completing the AZ Apex Pain Specialists Follow-Up Patient Medical History Intake Form online is a straightforward process designed to gather important information about your health. This guide will walk you through each section of the form to ensure you provide comprehensive and accurate details.

Follow the steps to effectively fill out the online form.

1. Press the ‘Get Form’ button to download and open the form in your preferred editing application.
2. Begin by filling in your name and age at the top of the form. Ensure accuracy as this information is vital for your medical records.
3. Enter today’s date and your date of birth. This helps the medical team track your medical history over time.
4. In the section labeled 'Referred By', please write the name of the individual or entity that referred you to AZ Apex Pain Specialists, if applicable.
5. Describe the problem or issue that brings you to the clinic today. Be as detailed as possible to assist the medical team in understanding your concerns.
6. Indicate whether your symptoms since your last visit are better, worse, or unchanged by marking the appropriate option.
7. If you have undergone any treatment since your last visit, please describe the treatment and its effectiveness.
8. On the provided scale of pain, please mark your level of discomfort today. This scale ranges from 'No pain' to 'Worst pain ever'.
9. Describe how your pain feels by selecting from the options provided, such as 'Dull', 'Sharp', or 'Aching'. You may select multiple options.
10. Using the designated area, indicate where you experience pain or discomfort by drawing or marking directly on the form.
11. Outline the time course of your pain by selecting the option that best describes it, such as 'Constant' or 'Improving'.
12. List any associated symptoms you may be experiencing, if applicable.
13. Identify what factors alleviate your pain and what may exacerbate it.
14. Mention your current exercise routine or any limitations in your activities due to pain.
15. Indicate if you use mobility aids, such as a cane or walker.
16. List any activities you are currently unable to perform due to pain and describe any impact on your sleep.
17. Provide information on any current medications you are taking, including any new medications since your last visit.
18. Update any new medical problems, surgeries, or allergies you may have encountered since your last visit.
19. In the family history section, circle any applicable conditions that run in your family.
20. Fill in your social history, including changes in marital status, employment details, and substance use habits.
21. Indicate any symptoms listed under the review of symptoms by circling those you are currently experiencing.
22. Review all the information you have entered to ensure accuracy. Make necessary edits if required.
23. Once completed, you can save your changes, download your filled-out form, print it, or share it as necessary.

Begin filling out your AZ Apex Pain Specialists Follow-Up Patient Medical History Intake Form online now.