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Numeric Pain Rating Scale
Numeric Pain Scale
Name
First
Last
Pain Intensity
0
1
2
3
4
5
6
7
8
9
10
Over the past 24 hours, how bad has your pain been? (0 = no pain, 10 = pain as bas as it can be). Please select one.
Forms
CPA Cheetahs Football Health Form
West Bedford Wolves Football Health Form
U15 Major Gulls Health Form
Consent to Release Information to WCB & MVA Insurance
Chiropractic Intake Form
Consent to Dry Needling & Acupuncture
Custom Page Title
U18 Major Halifax McDonalds Health Form
Numeric Pain Rating Scale
St. Marget’s Bay Rebels Medical Form
U16 AAA Buccaneers Health Form
Intake Form
Motor Vehicle Accident (MVA) Information Form
Workers’ Compensation Board (WCB) Information Form
Consent to Chiropractic and Acupuncture
Neck Disability Index
Oswestry Low Back Pain Questionnaire
Disabilities Of The Arm, Shoulder and Hand (DASH)
Lower Extremity Function Scale (LEFS)
WCB Orebro Activity Screening
