Evaluation Questionnaire Hello, Gen Rosaes . You are scheduled for an evaluation regarding your Workers’ Compensation case. This evaluation can take upwards of two- and-a-half hours; however, if you complete this form ahead of time and bring it with you to the appointment, the evaluation will take uci less time. Please call us our Edmond office at (405) 848-9306 with any questions you may have. 1.) Are you experiencing pain FROM YOUR CURRENT WORKERS’ COMPENSATION INJURY? Piease describe the LOCATION and severity 2.) Where would you rate your pain on a scale of one to ten? 10 3.) Are there tasks you previously performed which are now difficult? Please describe. (Examples: dressing yourself, cooking, cleaning, mowing, hygiene...)