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What best describes the status of your AS?


Pick one

What AS symptoms have you experienced recently?


Choose all that apply

Where do you feel pain or stiffness from your AS symptoms
most frequently?


Choose all that apply

My overall pain severity is:


No pain

Severe pain

Do you have difficulty doing any of these tasks or movements without assistance?


Choose all that apply

What changes have you made because of your AS symptoms?


Choose all that apply

What's one personal or physical goal you want to focus on with the help of your rheumatologist?


Some examples: "Go on a road trip with less AS pain." "Start up my cooking hobby without AS getting in the way." "Be able to take my dog on morning walks."

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1. I am currently:

You have chosen not to answer this question.

 

2. Recently I've experienced:

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  • Other(s):  

3. I feel pain and stiffness most often in:

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My overall pain severity scale is:


No pain

Severe pain

4. Because of my AS symptoms, I have difficulty with:

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5. Because of my AS symptoms, I have made the following changes:

You have chosen not to answer this question.

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  • Other(s):  

6. A new goal I want to strive for is:

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This is not a diagnostic tool. Discuss results with your rheumatologist.

Total Impacted time:

 
 

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