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RADU PHYSIATRYPre-visit pain intake ← Back to the main site
🔒 Private by design. Your answers stay on this device only — nothing you type is sent over the internet and nothing is saved. Closing or resetting this page erases everything.

Tell us about your pain — before your visit

Answer a few guided questions (about 3–5 minutes). At the end you'll get a summary for your care team — show the QR code at the front desk, print it, or copy it. Nothing you type here leaves this device.

🖥 Clinic staff: this page also works with no internet — use your browser's Save function (File → Save Page) to keep an offline copy on the clinic tablet or computer.

About this form: your answers are used only to draft a summary for your visit at Radu Physiatry and exist only on this screen until it is cleared. This page makes no network connections, stores nothing on the device, and uses no cookies or analytics. The one optional exception is voice typing: if you choose to use it, your device's built-in speech service converts your speech to text, and on some browsers that audio is processed by the browser's speech provider — skip it and type if you prefer. It is not for emergencies — if you have new loss of bladder or bowel control, new severe weakness, chest pain, or another emergency, call 911 now. This form does not provide medical advice.