Welcome to GoodVitals

We help patients across the United States receive clinician-guided evaluation and care for chronic pain using evidence-based, non-surgical approaches.

This form helps us:

Understand your pain history and symptoms

Determine whether our chronic pain program may be appropriate

Coordinate care with a licensed medical professional

Insurance-Covered
Video Consultation

We accept most major
health plans

Before any treatment recommendations can be made, you must complete a video consultation with one of our licensed medical professionals.

This is required for medical safety and insurance compliance.

All treatment decisions follow clinical evaluation and established medical guidelines.

Required acknowledgment

I understand that a video consultation is required before any treatment recommendations are made.

Pain Screening & History

The following questions help your clinician understand the nature of your pain and determine whether further evaluation may be appropriate.

How long have you been experiencing pain?

Less than 3 months

3–6 months

More than 6 months

Pain Screening & History

The following questions help your clinician understand the nature of your pain and determine whether further evaluation may be appropriate.

Where do you primarily experience pain?

Neck

Upper back

Lower back

Shoulder

Hip

Knee

Multiple areas

Pain Screening & History

The following questions help your clinician understand the nature of your pain and determine whether further evaluation may be appropriate.

How would you describe your pain?

Dull or aching

Sharp or stabbing

Burning or tingling

Throbbing

Stiffness

Pain Screening & History

The following questions help your clinician understand the nature of your pain and determine whether further evaluation may be appropriate.

Pain Screening & History

The following questions help your clinician understand the nature of your pain and determine whether further evaluation may be appropriate.

Does your pain limit your daily activities or sleep?

Yes

Pain Screening & History

The following questions help your clinician understand the nature of your pain and determine whether further evaluation may be appropriate.

Have you experienced symptoms such as numbness, tingling, or pain that travels down an arm or leg?

Yes

Pain Screening & History

The following questions help your clinician understand the nature of your pain and determine whether further evaluation may be appropriate.

Have you previously received treatment for this pain?

Yes

Verify Insurance & Schedule Consultation

Please provide the information below so we can review eligibility and schedule your required video consultation.

Select payment method^*

Insurance

Self-pay

Full Name^*

Insurance Provider (if applicable)

Member ID (if available)

Phone Number^*

State

Email Address^*

*Information is used only for medical review, insurance verification, and care coordination.

Proceed By Phone

Welcome to GoodVitals

Insurance-Covered Video Consultation

We accept most major health plans

Pain Screening & History

Pain Screening & History

Pain Screening & History

Pain Screening & History

Pain Screening & History

Pain Screening & History

Pain Screening & History

Verify Insurance & Schedule Consultation

Insurance-Covered
Video Consultation

We accept most major
health plans