Pain management telephone appointments form

Please note, this page is printable by selecting the normal print options on your computer.

Telephone/Video Consultation Template

This form is for your information and to enable you to be prepared for your telephone or video consultation with the clinical team.

This set of questions will make the consultation with the doctor or nurse more efficient and will enable us to give you and your GP the best advice. This is only a guide, the approach to the questions/consultation will vary between clinicians.  If you have missed your appointment, please do not call back as we have a high volume of calls.  We will send you the details of the next available slot.  We can only offer a maximum of 2 attempts. You will not be discharged from the Pain Clinic but will be kept updated. Please have all your medication and prescription to hand.

We will try our best to call you at the appointment time you have been given, however that may not always be possible.  Please try to make yourself available to receive the call for approximately one hour.

Questions that may be asked. It may be helpful to have thought them through:

1. What condition are you attending the Pain Clinic for?
2. How is your pain? Pain score 0 – 10
3. What has the pain stopped you from doing?
4. How are you coping? How is your mood?
5. What are your expectations from this consultation?
6. Do you have any questions?

Have you tried any of these treatments?

	Yes	No
Physiotherapy
Hydrotherapy
Acupuncture
TENS
Pain Psychology
Pain Management Programme
Injections