Welcome To { Sattvik Spine & Scoliosis Center ! }

Online Query


Putting patient’s interests before everything else!
Caring & curing with compassion!

Dr. Pithwa is a Consulting Spine Surgeon, practicing in Bangalore, India. You can reach him regarding any queries related to spine surgery by filling up the following questionnaire.

Personal Information






FemaleMale


Complaints

# Issue Status If yes, Duration in months Other Comments
1 Backpain
YesNo
2 Does the backpain wake you up in the night?
YesNo
3 Do you have pain going down from the back to the legs?
YesNo
4 Do you have tingling sensations/ numbness in the hands/ legs?
YesNo
5 Do you have any weakness in the hands/ legs?
YesNo
6 Do you have any unsteadiness while walking?
YesNo
7 Do you smoke?
YesNo
8 Do you have diabetes?
YesNo
9 Do you ride 2-wheelers?
YesNo
10 Have you taken any particular treatment for this problem?
YesNo
11 On a scale of 0 to 10, if 0 is no pain and 10 is maximum tolerable pain, how much pain do you have, looking back at the past one week? How severe is your pain in terms of activity restriction?
12 Restricts recreational activities
YesNo
13 Restricts occupational activities
YesNo
13 Restricts basic activities such as taking bath, wearing clothes, brushing teeth, etc.
YesNo
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