Pacifica Pain Management Services, Inc.

Chronic Pain Syndrome

Comprehensive Evaluation

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Welcome to the Comprehensive form of our chronic pain evaluation. We will make this as “painless” as possible. This should take about 60-80 minutes to complete. These questionnaires are completed online and sent electronically. Remember, if you stop before completing an electronic questionnaire and close your computer, your data for that particular questionnaire will be lost and you will have to start it over again.

All information received is confidential and if sent electronically is encrypted. We follow the medical guidelines of security and privacy formulated by HIPAA.

Completion Questionnaire Estimates Completion Time
Describe Your Chronic Pain/ Pain Experience 30 minutes
Pain Syndrome Inventory / Stanford Surgical Satisfaction 20 minutes
Medication and Drug Inventory 30 minutes