Pain visit summary
Appointments go quickly. Fill this in beforehand to make a one- or two-page summary of where it hurts, how it affects you, what you’ve tried, your medicines and your questions. Every part is optional.
Tips for your appointment
- Bring your medicines, or their packets, as well as the list.
- Put your most important question first in case time runs short.
- Write down what you’re told, or ask if someone can come with you.
- The summary is your own account. Your clinician will ask their own questions and examine you; it doesn’t replace that.
- chest pain, or pain with shortness of breath
- new weakness, or numbness in the legs, groin or buttocks
- new trouble controlling your bladder or bowels
- severe pain after a fall or injury, or a limb that looks out of shape
- pain with a high temperature, or pain that is sudden and severe
If you’re worried or your pain is getting quickly worse, contact your doctor or a nurse advice line (NHS 111 in the UK) the same day.
Your privacy
Everything you type or mark stays in your own browser. We don’t receive it, store it or use it for analytics, and it never appears in the page address. We’ve also switched off Google Analytics on this page. If you tick “Keep my entries if I reload this tab”, your entries are kept in this tab only until you close it. Use “Clear everything” to remove them sooner. Files you save or print are yours to keep or delete.
Next steps
Looking for someone to see? Search our free physical therapy directory (US), UK physio directory or chiropractor directory. While you wait, our free guides for low back pain, neck pain, knee pain and shoulder pain may help. Check with your clinician which exercises suit you.