12218-AUS Rev. G HFX Accessory Guide (AUS) web -compressed

How long have you been suffering from pain?

Less than 6 months 6 to 12 months More than 12 months

I am answering these questions for:

Myself A relative or friend

Where is your pain located?

(Select all that apply)

Neck

Upper Back

Mid Back

Lower Back

Buttocks

Groin

Chest

Belly

Arm(s)

Leg(s)

Foot/Feet

Other

Please select one or more answers

Next

On average, rate your pain level over the past 30 days:

No Pain

0 1 2 3 4 5 6 7 8 9 10

Worst Pain Imaginable

No Pain

Worst Pain Imaginable

Which treatments have you already tried?

(Select all that apply)

Epidural injections

Nerve ablation

Spine surgery

Spinal cord stimulation

Implantable pain pump

Physical therapy

Chiropractic care

TENS Unit

Other

Please select one or more answers

Next

What does your pain stop you from doing?

(Select all that apply)

Getting sleep

Working

Basic tasks around the house

Playing with kids or grandkids

Walking or shopping

Hobbies or other activities

None of the above

What statement describes you best?

I'm exploring my treatment options before I find a pain specialist I'm exploring my treatment options with a pain specialist My doctor has recommended a spinal cord stimulator and I am considering trying a temporary system I am scheduled to try a temporary spinal cord stimulator I am scheduled to receive an implanted spinal cord stimulator I currently have a spinal cord stimulator implanted

Please select your primary type of health insurance:

I have private health insurance I do not have private health insurance I have a Department of Veteran Affairs card I have an active workcover (or similar) claim Unknown

Thank you for sharing your experience.

Unfortunately, chronic pain is complex and it is unclear if you are an appropriate candidate for spinal cord stimulation at this time. Only a physician can recommend a specific treatment, we suggest you continue this discussion with your physician.

Start Over

Your pain condition appears similar to other people being treated with Spinal Cord Stimulation.

Get your discussion guide to start a conversation with your doctor.

First NamePlease enter your first name.
Last NamePlease enter your last name.
Date of BirthPlease enter your date of birth.
Email AddressPlease enter a valid email address.
Postal CodePlease provide a valid Australian postal code.
Phone NumberPlease provide a proper phone number.

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Please find a copy at the email address provided.

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Here’s what’s next:

Please expect a call from 0488 845 285. That’s your HFX Coach calling to answer your questions and help you find an HFX-trained doctor in your area.

Find a Physician

Thank you for your time.

We did not update your responses. Your results and discussion guide will be based on your previous responses. Please find a copy at the email address provided.

Find a Physician

How long have you been suffering from pain?

I am answering these questions for:

Where is your pain located?

On average, rate your pain level over the past 30 days:

Which treatments have you already tried?

What does your pain stop you from doing?

What statement describes you best?

Please select your primary type of health insurance:

Thank you for sharing your experience.

Your pain condition appears similar to other people being treated with Spinal Cord Stimulation.

Get your discussion guide to start a conversation with your doctor.

Our Spinal Cord Stimulation Care Team is happy to have a conversation with you about Spinal Cord Stimulation Care. If you share your phone number, they can call you back and answer any questions you may have.

Agree to terms

Looks like you have recently taken the assessment.

Would you like to update your responses?

Your responses have been saved.Thank you for your time.

Thank you.

Thank you for your time.

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