Step 2 of 5 - Medical questionnaire

Medical questionnaire

About 3 minutesPrivate doctor review

To order Tramad Capsules, you must fill out this questionnaire.

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Disclaimer

This questionnaire forms the basis for your consultation today. We expect truthful and transparent answers from you, including information on all current medications you are taking, your medical history, and any other information our doctors should be aware of. This will allow our doctors to provide you with the best possible advice and select the most suitable medications for you. Please read all medical information before choosing your preferred treatment.

Question 1Do you know the cause of your pain?

YesNo

Question 2On a scale of 1 to 5, how would you rate the intensity of your pain?

Mild painModerate painSevere pain

Question 3How often do you experience this type of pain?

This is a one-time injury/illnessDailyA few times a weekWeeklyEvery two weeksMonthly

Question 4What makes the pain worse?

Question 5Are you aware that you should speak to your doctor in the following cases: the treatment does not improve your pain, your pain is getting worse, you are in severe pain, the pain spreads to other parts of your body, or your pain significantly impacts your quality of life?

YesNo

Question 6Are you taking any of the listed medications that may interact with pain treatment?

NoYes

Question 7Does any of the following apply to you?

NoYes

Question 8Are you pregnant or breastfeeding?

NoYes

Question 9Are you currently being treated by a hospital specialist, or have you recently seen one?

NoYes

Question 10Have you already had any diagnostic tests performed (X-ray, MRI, etc.)?

YesNo

Question 11Have you ever tried an over-the-counter pain reliever?

YesNo

Question 12Do you drink alcohol daily?

NoYes

Question 13Do you have a history of drug or alcohol addiction?

NoYes

Question 14Are you currently taking any medication (including over-the-counter, prescription, or recreational drugs)?

YesNo

Question 15Are you aware of and agree to the medication safety guidelines?

YesNo

Question 16I agree to the terms and conditions and confirm that I am over 18 years old.

I AgreeI Do Not Agree