Where is the pain?
Is it sharp, dull, constant or does it come and go?
Does it radiate or go elsewhere?
What were you doing when it came on?
Does anything you do relieve or improve the pain?
Does anything make the pain worse?
On a scale of 1 to 10, how severe is the pain.
How do you feel in yourself? Do you feel unwell or poorly?
Have you had any fever or temperature with this problem?
Depending on the bodily system associated with your problem, please comment on whether you have experienced any of the following associated symptoms that are of NEW ONSET in the last 4 weeks:
General symptoms:
Persistent fever, drenching sweats at night (having to change clothing or bedding), unintentional weight loss, loss of appetite, spontaneous bruising or bleeding?
Eye Problems:
New onset visual impairment or blurring, any floaters or flashing lights.
Head and neck:
Vomiting, headache when waking from sleep, worse with coughing or sneezing, double vision, fits/faints/funny turns or vertigo.
A new swelling in the head and neck area.
Difficulty swallowing or a hoarse voice.
Chest Problems:
Coughing up blood, a hoarse voice, fatigue, progressively worsening shortness of breath.
Stomach Problems:
New change in bowel habit, unexplained bleeding with bowels, persistent diarrhoea, mucous with stools, vomiting and progressive difficulty swallowing solid foods or fluids.
Urinary Problems:
Blood in the urine, passing urine more often, burning, cloudy urine, associated pain in the back or sides/flank, getting up at night to pass urine
Skin lesions:
Change in size, shape or colour, inflammation, oozing, change in sensation
Back Pain:
Problems with bowel and bladder function (usually inability to pass urine), numbness in the saddle area (around the back passage (anus)) and weakness in one or both legs.
Joint problems:
Any fever/shivering stiffness in the joints that lasts more than 30 minutes when you wake up in the morning. Any bone pains?
Have you checked your Pulse, Oxygen Levels or Blood Pressure? If yes then please include these readings if you feel they are relevant to your problem.
Can you think of any other information which would be useful to the doctor in assessing your complaint?
Please provide contact details. The doctor may contact you via text message, email or telephone consultation depending on what is most appropriate. Online consultation requests should be such as to be able to be completed without a phone call.
