Back Pain Pre-Exam Form in Chapman
The hardest part of a first appointment is usually trying to describe a back you have been guarding for months while somebody waits with a pen. So here are the questions in advance. Look them over before you come to our Chapman clinic, answer the ones you can, and let your therapist spend the visit on your back instead of a clipboard.
What your back pain pre-exam covers.
Two people can say the exact same sentence, “my lower back is killing me,” and need two completely different plans. A back that flares from sitting behaves nothing like a back that flares from standing. The groups of questions below are how your therapist tells them apart.
Have a look before your appointment. Answer them in your head, in your notes app, on a scrap of paper. There is nothing to submit here and nothing to print. When you want a time, the booking form further down this page is the whole process.
Where it sits, where it travels
Show us the spot. Centred in the low back, off to one side, or spread across the belt line? Then tell us whether it stays put or runs into the buttock, down the back of the thigh, past the knee, into the calf or foot. How far it travels tells us how much the nerve is involved.
Back pain & sciatica →What makes it worse, what settles it
The drive to work. Standing at the sink. Bending to pull something out of the dryer. The first few steps out of bed in the morning. Tell us which of those spikes it and which of them eases it, because a back that hates bending needs the opposite plan from a back that hates standing.
Request an appointment →Numbness, tingling and weakness
Pins and needles, a numb patch of skin, a leg that feels like it might give out under you. Note where it is and when it appears. One item is urgent: if you have new changes in bladder or bowel control, or numbness through the saddle area, call us immediately or go straight to the emergency room. Do not wait for your appointment.
Call (785) 922-4016 →How long, and what has been tried
When it started and whether anything set it off. Whether this is the first episode or one of many. Any imaging you have had, and what the X-ray, MRI or CT report actually said. Previous treatment, injections or surgery, and what changed after each one. If you were told to rest it, that counts, so tell us.
Common questions →What to bring to your first visit
- Your prescription, if a physician has already written you one
- Your driver’s licence or another photo ID
- Your insurance cards, or your Worker’s Comp or auto claim information
- A list of your medications with the dosage and how often you take them
- Copies of any X-ray, MRI or CT reports connected to your back
- Your personal calendar, so we can schedule the rest of your visits before you leave
Kansas direct access means most patients can start physical therapy without a physician referral, so you are free to call and be evaluated. A few insurance plans still require one for coverage. We check your specific plan before your first visit and tell you exactly where you stand, rather than letting you find out afterwards.
Your Chapman clinic
Tues and Thurs, 7:20 am to 5:00 pm
None of this is homework. If writing it out is not your thing, call (785) 922-4016 and answer these on the phone, or come in a few minutes early and go through them with us at the front desk. Nobody is turned away for arriving with nothing but the problem itself. Use the form below and we will call you back to lock in a time.