• Image-206
  • Thank you for reaching out to us.

    To effectively assess your situation, we ask for your cooperation in providing some necessary information.

    A significant portion of the details we require is obtained using the electronic Persistent Pain Outcomes Collaboration (ePPOC) standard forms, which involves collecting pertinent information used by specialized pain services. This data serves multiple purposes, including guiding personalized treatment plans, evaluating outcomes post-treatment, and establishing benchmarks within the pain management sector.

    Once you've completed and submitted this form, you'll be directed to a booking page where you can select a convenient time for a 30-minute consultation.

    During this consultation, one of our team members will review your case and offer insights into potential beneficial services, including those covered by Medicare, which you may or may not currently access.

    We look forward to assisting you further.

    If you have any questions or concerns contact us

     

  • Client Pain Questionnaire

    Client Pain Questionnaire

  • Section 1 Part A - Your General Details

  •  - -
  •  - -
  •  -
  •  -
  •  - -
  • BMI (adults)  Classification 
    Less than 18.5               Underweight
    18.5 to 24.9 Healthy weight
    25 to 29.9 Overweight but not obese
    30 to 34.9 Obese class I
    35 to 39.9 Obese class II
    40 or more Obese class III
  • Section 1 Part B - Your Care Team

  • Have you seen any of the following Health Professionals in the last six months concerning your pain?

  • Please provide the following details

  • Section 1 C - Your Pain Profile

  •  
  • Section 2 - Your Work

  • Section 3 - Medication use

  • Section 4 - Pain intensity and interference

  • Please rate your pain by selecting the number that best describes the following

    0 = No pain

    10 = Pain as bad as you can imagine

  •  
  • During the past week, how much has pain interfered with the following:

    0 = Does not interfere

    10 = Completely interferes

  •  
  • Section 5 - DASS21

  • Please read each statement and make a selection that indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

  •  
  • DASS Results

    The DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. ePPOC uses the short version of the DASS, the DASS21
  • Depression

    Normal               Mild                Moderate            Servere              Extremely Servere   
     0-9 10-13  14-20  21-27  28+ 
  • Anxiety

    Normal               Mild                Moderate            Servere              Extremely Servere   
     0-7 8-9 10-14 15-19 20+ 
  • Stress

    Normal               Mild                Moderate            Servere              Extremely Servere   
     0-14 15-18 19-25 26-33 34+ 
  • Section 6 - PSEQ

  • Rate how confident you are that you can do the following things at present despite the pain. Select one of the numbers on the scale under each item, where

    0 = Not at all confident and

    6 = Completely confident.

    Remember this questionnaire is not asking whether or not you have been doing these things, but rather how confident you are that you can do them at present, despite the pain.

  •  
  • PESQ Results

    The Pain Self-Efficacy Questionnaire (PSEQ) is a measure of how confident a patient is that he or she can do a range of activities despite their pain.
  • Severe Moderate Mild Minimal
    Less than 20 23-30 31-40 more than 40

     

  • Section 7 - PCS

  • Everyone experiences painful situations at some point in their lives. Such experiences may include headaches, tooth pain, joint or muscle pain. People are often exposed to situations that may cause pain such as illness, injury, dental procedures or surgery.

     

    We are interested in the types of thoughts and feelings that you have when you are in pain. Listed below are thirteen statements describing different thoughts and feelings that may be associated with pain. Using the scale, please indicate the degree to which you have these thoughts and feelings when you are experiencing pain.

  •  
  • PCS Results

    The Pain Catastrophising Scale (PCS) is a measure of an individual’s thoughts and feelings relating to their pain. The scale includes three sub scales measuring the dimensions of Rumination, Magnification and Helplessness.
  • Mild High Severe
    Less than 20 20-30 more than 30
  • PCS Subscales

  • Clinically significant scores for each of the subscales are

    Rumination: 11
    Magnification: 5
    Helplessness: 13

  • Medicare audit

  • One of our services is a review of your medicare allocations and entitlements. Based on your feedback for the questions below, we can give guidance on what you may be entitled to during your initial consultation with us. 

  • Not sure how to find out what Medicare Rebates you have received? Head to the Medicare online account page using this link

  •  - -
  •  - -
  •  
  • Thank You - your now ready to submit your form

  • Once you submit the form, you’ll be directed to our booking system, where you can choose a convenient time to complete your consultation with a member of our team.

  • Should be Empty: