Brief Pain Inventory
For completion by patients returning for review. To be completed by all returning patients. Please note; All clinical information that we hold regarding the assessment and treatment of our patients, for best practice purposes, is sent to patients' GPs so that primary care providers can see precisely what you have presented with and how we are treating you. Your medical history as described by you in this questionnaire forms the basis of the review with your Consultant and provides essential background information regarding your pain/condition, and as such it is sent to your GP with your clinic review letter.
Please note, all information given on this proforma remains confidential and is held securely by London Pain Clinic in accordance with the Data Protection Act 1998.The information is used to help simplify your assessment and to enable maximum time to be spent on examination and discussion during your assessment. It is no way a substitute for a full consultation and examination. Thank you for taking the time to complete this questionnaire.
Please note that the outcome will be based on the information you have provided. Therefore, London Pain Clinic accepts no responsibility for advice/information given relating to any incomplete, inaccurate or incorrect information you have provided.