Pain Management Intake Forms
Every pain management intake form a clinic uses, explained: what each one asks and why.
From the new patient intake and Brief Pain Inventory to spine pain, injection and opioid safety questionnaires. Pick a form to see its questions.
Pain management intake forms by area
Forms grouped by the area of pain care that uses them. Every clinic words its own forms differently; each page shows what a typical form asks.
- New patient and follow-up 3
- Spine pain 3
- Headache and nerve pain 3
- Chronic pain conditions 2
- Injections and procedures 5
- Advanced therapies 3
- Opioid safety 2
- Cancer and pediatric pain 2
New patient and follow-up
3 forms- Brief pain inventory Coming soon
- Pain management follow up questionnaire Coming soon
- Pain management new patient intake Coming soon
Spine pain
3 forms- Low back pain questionnaire Coming soon
- Neck pain questionnaire Coming soon
- Sciatica questionnaire Coming soon
Headache and nerve pain
3 forms- CRPS questionnaire Coming soon
- Headache questionnaire Coming soon
- Neuropathic pain questionnaire Coming soon
Chronic pain conditions
2 forms- Chronic post surgical pain evaluation Coming soon
- Fibromyalgia questionnaire Coming soon
Injections and procedures
5 forms- Epidural steroid injection pre-procedure questionnaire Coming soon
- Nerve block pre-procedure questionnaire Coming soon
- Post injection pain relief diary Coming soon
- Radiofrequency ablation pre-procedure questionnaire Coming soon
- Trigger point injection pre-procedure Coming soon
Advanced therapies
3 forms- Intrathecal pump evaluation Coming soon
- Ketamine infusion pain screening Coming soon
- Spinal cord stimulator evaluation questionnaire Coming soon
Opioid safety
2 forms- Opioid risk tool Coming soon
- Pain management controlled substance agreement Coming soon
Cancer and pediatric pain
2 forms- Cancer pain management intake Coming soon
- Pediatric pain clinic intake Coming soon
Pain management intake forms: FAQ
What intake forms does a pain management clinic use?
Most clinics start with a new patient intake and a pain rating tool such as the Brief Pain Inventory. Many add condition forms for back, neck or nerve pain, pre-procedure questionnaires for injections, and opioid safety forms when medicines are part of the plan.
What does a pain management intake form ask?
It asks where the pain is, when it started, how strong it is, what it feels like and what makes it better or worse. It also covers past treatments, medicines, surgeries, imaging, and how pain affects sleep, mood, work and daily activities.
What is the Brief Pain Inventory?
The Brief Pain Inventory is a short questionnaire from the MD Anderson Pain Research Group. Patients rate their pain on 0 to 10 scales and say how much it interferes with activity, mood, walking, work, relationships, sleep and enjoyment of life.
Why do injection procedures need their own questionnaire?
Before an injection, the team needs procedure-specific details: current blood thinners, allergies, diabetes, possible pregnancy, recent infections and whether someone can drive the patient home. A post-injection diary then records how much the pain changed in the hours and days after.
How does AI Doctor help a pain management clinic?
AI Doctor, a real-time AI healthcare assistant avatar, asks the intake questions as a conversation, in the patient's own language, and collects the answers for the team to review.
Which form should a new pain clinic start with?
Start with the pain management new patient intake, since every patient needs one. Then add the Brief Pain Inventory or a follow-up questionnaire to track change over time, and pre-procedure forms for the injections you offer.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
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- 01Choose the AI Doctor avatar.
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