Calculate severity of neck &/or low back pain for medical necessity & therapeutic care
Please Email your completed form to: provider@communitywellnessamerica.org secured HIPAA compliant
English Language CalculatorsDo you have Neck Pain or decreased movement
Do you have any Low Back Pain or decreased movement
Does your health now limit you in these activities?
Physical, Emotional, Energy, Social, Pain, General Health
how you feel about your quality of life, physical, psychological, social, and environment
Preguntas de salud en español (Spanish Translation)