New Patient Questionnaire

To be completed by all new patients. Your medical history, as described in this questionnaire, will form the basis of your assessment with DR Krishna It provides essential background information regarding your pain condition, and makes the consultation process more efficient.

Please ensure you fill in the required fields marked with an asterisk (*)

Name*
First Last
Address
Street Address City County / State / Region ZIP / Postal Code
Phone
Email Address*
Best time to call
Questions & Comments*
Phone
This field is for validation purposes and should be left unchanged.

Please note, all information given on this proforma remains confidential. Thank you for taking the time to complete this questionnaire.

Please note that the outcome will be based on the information you have provided. Therefore, Pain Spa Limited accepts no responsibility for advice/information given relating to any incomplete, inaccurate or incorrect information you have provided.

Have a question? Or would like to book in with us?

Get in Touch

Common Conditions
that we Treat Everyday

View All Conditions

Latest from the Blog

Posted 07 Feb, 2019

Intraarticular Pulsed Radiofrequency vs. Radiofrequency Neurotomy in Patients with Chronic Knee Pain due to Osteoarthritis (OA)

Advanced age usually suffer from painful osteoarthritis of knee (OA). Treatment of OA pain by non- steroidal anti-inflammatory is of restricted benefit and surgery is challenging in many patients due to associated medical problems. In this study we used either intraarticular PRF or radiofrequency neurotomy to control p...

Posted 07 Feb, 2019

Stellate Ganglion Block a Potential Lifesaver in Severe PTSD

Case reports are mounting of immediate, durable, and significant relief of severe refractory symptoms of posttraumatic stress disorder (PTSD), according to an anesthesiologist who has seen the benefits firsthand. Stellate ganglion blockade (SGB) “seems to significantly improve PTSD symptoms as well as significant...

Posted 25 Jan, 2019

CGRP Antagonists: A new era for migraine treatment

Migraine is a common medical condition, affecting as many as 37 million people in the US. It is considered a systemic illness, not just a headache. Recent research has demonstrated that changes may begin to occur in the brain as long as 24 hours before migraine symptoms begin. Many patients have a severe throbbing head...

"I am writing to convey my gratitude for what you have done for me. After 18 years I have managed to get some relief from my back complaint. Thank you from the bottom of my heart as no one else has managed to help me. You have given me the chance to enjoy my life again!"
NS, Berkeley
"Dr Krishna is a very kind and gentle man who always makes me feel at ease and explains every thing in a way that I can understand. His treatment has helped me stay in my job and enjoy my hobbies."
RB, Bristol
"Dr Krishna has been absolutely amazing. He treated my abdominal pain when no one else could help. The nerve ablation procedure he performed on me has changed my life completely for the better. Now I can enjoy my life rather than feeling sorry for myself!"
GK, Bolton
"Words are not enough, I need to write and thank you for all your help with my pain and fatigue. We are indeed very lucky to have doctors like you. You are special!"
MB, Bristol

New Patient Questionnaire

Have a question? Or would like to book in with us?

Common Conditionsthat we Treat Everyday

Latest from the Blog

"I am writing to convey my gratitude for what you have done for me. After 18 years I have managed to get some relief from my back complaint. Thank you from the bottom of my heart as no one else has managed to help me. You have given me the chance to enjoy my life again!" NS, Berkeley

"Dr Krishna is a very kind and gentle man who always makes me feel at ease and explains every thing in a way that I can understand. His treatment has helped me stay in my job and enjoy my hobbies." RB, Bristol

"Dr Krishna has been absolutely amazing. He treated my abdominal pain when no one else could help. The nerve ablation procedure he performed on me has changed my life completely for the better. Now I can enjoy my life rather than feeling sorry for myself!" GK, Bolton

"Words are not enough, I need to write and thank you for all your help with my pain and fatigue. We are indeed very lucky to have doctors like you. You are special!" MB, Bristol

Common Conditions
that we Treat Everyday

"I am writing to convey my gratitude for what you have done for me. After 18 years I have managed to get some relief from my back complaint. Thank you from the bottom of my heart as no one else has managed to help me. You have given me the chance to enjoy my life again!"
NS, Berkeley

"Dr Krishna is a very kind and gentle man who always makes me feel at ease and explains every thing in a way that I can understand. His treatment has helped me stay in my job and enjoy my hobbies."
RB, Bristol

"Dr Krishna has been absolutely amazing. He treated my abdominal pain when no one else could help. The nerve ablation procedure he performed on me has changed my life completely for the better. Now I can enjoy my life rather than feeling sorry for myself!"
GK, Bolton

"Words are not enough, I need to write and thank you for all your help with my pain and fatigue. We are indeed very lucky to have doctors like you. You are special!"
MB, Bristol