Body Pain Location Chart

NAME_______________________________________________ Date ___________

Mark in the areas of your body that you now feel your typical pain. Include all affected areas.

Use the appropriate symbols indicated below:

Pain = XXXXX

Numbness = OOOOO

Pins and Needles ===== ====

Stabbing //////////

Front

Back

Bac

Left

Right

Left

Right

Please mark on line: How bad is your pain now on a scale from 0-10

0-------------------------------------------------------------------------------------------------------------------------10

0 votes

Parent category: Medical