Low Back Pain/Acute Injury – GoodpillRx

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Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

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Women
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Lab Testing
Active Aging
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Latest Medications

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Home
Shop
For Providers
About us
Contact us

Generic selectors

Exact matches only

Exact matches only

Search in title

Search in title

Search in content

Search in content

Search in excerpt

Post Type Selectors

product

product

post

post

page

page

product variation

product_variation

Filter by Categories

Uncategorized

Uncategorized

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Low Back Pain/Acute Injury

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

What is your date of birth?*

MM slash DD slash YYYY

What is your height?*

What is your weight?*

What is your gender?*

Male

Female

Are you currently breastfeeding, currently pregnant, or may become pregnant in the near future?*

Yes

No

Not sure

Please list all medications prescribed to you even if you don't take them every day. Include vitamins, and dietary supplements. Enter medicines including name, dose, frequency, and reason for taking.*

Please list your allergies, including any allergies to medications.*

When did the low back pain start?*

What were you doing when it started?*

What makes the pain better?*

What makes the pain worse?*

How would you describe the pain? (i.e. stabbing, shooting, throbbing/pulsating, cramping, etc)*

Does the pain radiate to other parts of the body?*

Yes

No

Where does it radiate to?*

On a scale of 1-10, how severe is the pain?

Has the pain been constant or intermittent (comes and goes)?

Constant

Intermittent

Has the pain been getting better, progressively worse or staying the same?*

Getting better

Staying the same

Progressively worse

Did you recently suffer from an injury to the back?

Yes

No

How did the injury occur?

Have you used any over-the-counter products to treat the pain?*

Yes

No

What treatment have you used?*

Have you had any of the following?

Unexplained weight loss

Pain does not improve despite over-the-counter treatments

Pain at night or when resting

Recent fever

Recent infection (i.e. UTI, cellulitis, pneumnia, etc)

Decreased sensation of the legs

Weakness of the legs

Involnutary loss of urine

Involnutary loss of feces

Do you have osteoporosis?*

Yes

No

Have you been diagnosed with diabetes?*

Yes

No

Please list all of the medical conditions you are currently diagnosed with that were not already addressed.

Provide a recent heart rate and blood pressure measurement. This can be from a recent appointment (within the past 6 months) or you can have these measured for free at most local pharmacies such as CVS or Walgreens.

Finally, is there anything else we should know?*

Yes

No

Please briefly explain.*

GoodpillRx is dedicated to helping our patients have access to quality, affordable medications, delivered straight to their door.

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