Schritt 2 von 5 - Medizinischer Fragebogen

Medical questionnaire

Etwa 3 MinutenPrivate ärztliche Prüfung

Um Tramad Capsules zu bestellen, müssen Sie diesen Fragebogen ausfüllen.

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Wichtiger Hinweis

Dieser Fragebogen bildet die Grundlage Ihrer heutigen Konsultation. Bitte beantworten Sie alle Fragen wahrheitsgemäß und vollständig, einschließlich aktueller Medikamente, Vorerkrankungen und weiterer relevanter Gesundheitsinformationen.

Frage 1Do you know the cause of your pain?

YesNo

Frage 2On a scale of 1 to 5, how would you rate the intensity of your pain?

Mild painModerate painSevere pain

Frage 3How often do you experience this type of pain?

This is a one-time injury/illnessDailyA few times a weekWeeklyEvery two weeksMonthly

Frage 4What makes the pain worse?

Frage 5Are you aware that you should speak to your doctor in the following cases: the treatment does not improve your pain, your pain is getting worse, you are in severe pain, the pain spreads to other parts of your body, or your pain significantly impacts your quality of life?

YesNo

Frage 6Are you taking any of the listed medications that may interact with pain treatment?

NoYes

Frage 7Does any of the following apply to you?

NoYes

Frage 8Are you pregnant or breastfeeding?

NoYes

Frage 9Are you currently being treated by a hospital specialist, or have you recently seen one?

NoYes

Frage 10Have you already had any diagnostic tests performed (X-ray, MRI, etc.)?

YesNo

Frage 11Have you ever tried an over-the-counter pain reliever?

YesNo

Frage 12Do you drink alcohol daily?

NoYes

Frage 13Do you have a history of drug or alcohol addiction?

NoYes

Frage 14Are you currently taking any medication (including over-the-counter, prescription, or recreational drugs)?

YesNo

Frage 15Are you aware of and agree to the medication safety guidelines?

YesNo

Frage 16I agree to the terms and conditions and confirm that I am over 18 years old.

I AgreeI Do Not Agree

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