Chronic Pain Scale Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Before completing this form, please read our Privacy Policy and sign the Consent with Respect to Treatment of Personal Information Form: Privacy Policy: https://loeysdietzcanada.org/wp-content/uploads/2024/04/2023-11-21_EN_LDSFC-Privacy-Policy.pdf Consent with Respect to Treatment of Personal Information: https://loeysdietzcanada.org/consent-re-personal-information/ Participant InformationName *Email *Graded Chronic Pain Scale1. In the past 3 months, how often did you have pain? *NeverSome DaysMost DaysEvery Day2. Over the past 3 months, how often did pain limit your life or work activities? *NeverSome DaysMost DaysEvery Day3. Now, think about pain you have had during the past 7 days, what number best describes your pain, on average? *0 (No pain)12345678910 (Pain as bad as you can imagine)4. During the past 7 days, what number best describes how pain has interfered with your enjoyment of life? *0 (Does not interfere)12345678910 (Completely interferes)5. During the past 7 days, what number best describes how pain has interfered with your general activity? *0 (Does not interfere)12345678910 (Completely interferes)6. Are you not working or unable to work due to pain or a pain condition? *YesNoSubmit
