Chronic Daily Headache Assessment & Referral Form

Streamline Chronic Headache Management with Smart Assessment Forms

If your healthcare practice regularly sees patients with chronic daily headaches, you know how time-consuming and complex these assessments can be. This Chronic Daily Headache Assessment Form template from Paperform helps you capture the detailed clinical information needed to evaluate headache patterns, medication overuse, disability impact, and referral criteria—all in one streamlined, patient-friendly experience.

Built specifically for neurologists, headache specialists, primary care providers, and pain management clinics, this template collects comprehensive headache diary data, medication history, disability scoring (HIT-6), and red flag symptoms to support accurate diagnosis and appropriate specialist referral.

Why healthcare providers choose Paperform for patient assessments

Unlike rigid survey tools, Paperform's doc-style editor lets you build forms that feel professional and branded to your practice. Add your logo, use conditional logic to show relevant follow-up questions based on headache type or medication use, and guide patients through complex assessments without overwhelming them.

Automate your clinical workflows with Stepper: Connect your assessment form to Stepper to automatically route high-risk patients to your referral coordinator, flag medication overuse cases for pharmacist review, send completed assessments to your EHR, and trigger follow-up appointment scheduling—all without manual data entry.

Secure consent and documentation with Papersign: Need patients to consent to specialist referral or medication changes? Use Papersign to turn form submissions into eSignature-ready documents, keeping all consent forms linked to the original assessment for complete audit trails.

With SOC 2 Type II compliance, data residency controls, and integrations with healthcare tools like Google Workspace, Airtable, and thousands of apps via Stepper, this template gives your practice a HIPAA-aware foundation for digital patient assessment (note: additional configuration required for full HIPAA compliance).

Whether you're a busy neurology practice managing referrals, a primary care clinic screening for chronic headache, or a headache center conducting intake assessments, this Paperform template helps you collect better data, reduce administrative burden, and get patients the right care faster.