This takes about 3 minutes. Tap the answers that fit, or use the microphone to speak instead of typing. There are no wrong answers — your therapist reviews everything.
02 In your own words, what's going on?
When did it start, and how did it happen?
04 How strong is the pain right now?
0 = none, 10 = worst imaginable.
06 Does it spread, or come with other feelings?
Select any that apply.
10 Important safety check
Tick anything you've noticed. These help us keep you safe — they don't necessarily mean anything is wrong.
Some of what you've ticked is worth a doctor's review soon. Please still complete this form — and if you have severe or worsening symptoms (especially loss of bladder/bowel control or numbness around the saddle area), seek urgent medical care today.