Pain, spine & orthopaedic care in Ocean & Monmouth County, NJ
Patient resources

Disability forms

Short questionnaires that measure how pain affects your daily life. Your score is calculated as you answer, and nothing you enter leaves your device.

Your care team may ask you to fill out one of these short questionnaires before a visit. They measure how back pain or other health problems affect your daily life. Each form adds up your score for you as you answer. Comparing scores over time helps you and your provider see how you are responding to treatment.

How to use these forms

  • Answer every question based on how you are now (or in the past 7 days, where the question says so).
  • Your score updates as you answer.
  • When you finish, choose Print / Save as PDF. Bring the printout to your appointment, or show the PDF to our staff.
  • Nothing you enter is sent to GSMC or stored on this website.

These scores do not diagnose a condition. Your provider will review them with you. If you have questions, call us at 732-202-3000.

Talk with a GSMC specialist

We will review your history and imaging and explain your options. Many plans, including Medicare, are accepted. We verify benefits before scheduling procedures.