Date of birth:

Do you have back pain?

YesNoOther

What is your back problem?

The pain is constantThe pain is periodicAcute painFractureHerniaWeather responseResponse to loadNo problemOther

Which part of your back bothers you the most?

Cervical departmentThoracic departmentLumbar sectionSacralCoccyxDoesn't botherOther

When does it hurt?

EveningDayMorningNight

What do you do when you are in pain?

NothingI wait for a certain time, then the pain passesI take medicineGoing to the doctorI go to the massage therapistOther

В якому положенні стає легше?

Lying downStandingSitting

When did it start to hurt?

Every daySeveral times a weekSeveral times a monthSeveral times a year

Does lying down make it easier?

YesNo

A feeling of lightness in the body?

IsSometimesThere is none

Rate the pain from 0 to 10

0 - you smile

10 - pain to tears

I know about the Questionnaire:

InstagramFacebookFrom friendsFrom adsI do not rememberGoogleOther

Phone number to contact you (Viber, Telegram, WhatsApp):