CONFIDENTIAL PATIENT HEALTH HISTORY FOR PAIN TREATMENT ...

Pain in hip joint (right or left?) Pain down leg (right or left?) Leg cramps (right or left?) Pins and needles in leg (right or left?) Numbness of leg (right or left?) Numbness of feet (right or left?) Numbness of toes. Feet feel cold (right or left?) Cramps in feet (right or left?) Swollen ankles. Painful joints in toes . LOW BACK: Low back Pain. Lower back pain worse when: Working. Lifting ... ................
................