Spinal Fusion Surgery Follow-Up Questionnaire

Patient Information

Full Name Date of Birth Date of Surgery Surgeon's Name

Post-Surgery Symptoms & Progress

Current Pain Level (0-10) Area(s) of Pain Do you feel improvement compared to before surgery? Yes No Unsure Describe your current mobility/physical activity

Medical Follow-Up

Are you currently taking pain or other related medication? Yes No Any side effects from medication? Have you experienced any complications since surgery?

Additional Notes

Questions or concerns for your care team