MPaCT Survey - Consumer

MPaCT (My Pain assessment Communication Tool) – Feedback Survey Trial
Developed by Dragon Claw, Painaustralia, and Pain Education Management

Thank you for taking a few moments to share your experience with MPaCT.

This survey is anonymous and confidential. We do not ask for your name or contact information. A few optional demographic questions help ensure we are hearing from a wide range of people.
Demographics (Optional):
Age

Under 1818–2930–4445–5960–7475+
Gender

MaleFemalePrefer to self-describe:
Primary Language

EnglishOther (please state your primary language)
Your Impressions of MPaCT
Overall, how satisfied were you with using the MPaCT tool?

Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied

How would you rate the following features of the tool?

	Very satisfied	Satisfied	Neutral	Dissatisfied	Very dissatisfied
The interactive body map:
The intensity (strength) words to describe your pain:
The characteristic (type/quality) words:
Did you add any words that weren’t included in the tool?

Suggestions for improvement:
Communication Support
Did MPaCT help you prepare for your conversation with a health care professional?

YesNoNot sure
Did it help you feel better understood or able to express your pain experience more fully?

YesNoNot sure
Do you feel the tool supported or improved the conversation with your health care provider?

YesNoNot sure
Final Thoughts

This is a work in progress and will continue to evolve.
We welcome any other comments you'dlike to share:
Thank you for sharing your feedback. Your voice matters—and helps improve tools for all of us living with chronic pain.
Should be Empty:

Demographics (Optional):