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Home
About Us
Our Facility
Meet Our Team
Treatment Areas
Back Pain
Neck Pain and Headaches
Shoulder Pain
Elbow Pain
Wrist/Hand Pain
Hip Pain
Knee Pain
Sports Injuries
Fibromyalgia
Specialties
Medication Management
Interventional Pain Procedures
Medical Weight Loss
Sleep Management
For Patients
Patient Forms
Blog
Lectures
Videos
Testimonials
Physicians
Referrals
Education and Training
Contact Us
Ronald Morris Low Back Questionnaire
Ronald Morris Low Back Questionnaire
Zahid Ramzan
2022-10-21T23:04:00+00:00
Ronald Morris Low Back Questionnaire
Date
MM slash DD slash YYYY
Patient Name
(Required)
First Name
Middle Name
Last Name
Date
MM slash DD slash YYYY
When you have chronic pain, you may find if difficult to do some of the things you normally do. Please mark with a cross only the sentences that describes you TODAY.
I stay at home most of the time because of my chronic pain.
I walk more slowly than usual because of of my chronic pain.
Because of my chronic pain, I am not doing any jobs that I usually do around the house.
Because of my chronic pain, I use a handrail to get upstairs.
Because of my chronic pain, I lie down to rest more often.
Because of my chronic pain, I have to hold onto something to get out of an easy chair.
Because of my chronic pain, I try to get other people to do things for me.
I get dressed more slowly than usual because of my chronic pain.
I stand up only for short periods of time because of my chronic pain.
Because of my chronic pain, I try not to bend or kneel down.
I find it difficult to get out of a chair because of my chronic pain.
I am in pain most of the time.
I find it difficult to turn over in bed because of my chronic pain.
I have trouble putting on my socks (or stockings) because of my chronic pain.
I sleep less because of my chronic pain.
I avoid heavy jobs around the house because of my chronic pain.
Because of my chronic pain, I am irritable and bad tempered with people more than usual.
Because of my chronic pain, I go upstairs more slowly than usual.
I change positions frequently to try to get comfortable because of my chronic pain.
My appetite is not very good because of my chronic pain
I can only walk short distances because of my chronic pain.
Because of my chronic pain, I get dressed with the help of someone else.
I sit down for most of the day because of my chronic pain.
I stay in bed most of the time because of my chronic pain.
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