Pain Screening Eligibility

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Pain Screening Eligibility

There are many types of pain. But if the pain you're experiencing prevents you from doing the things you love, consider taking the next step.

1
Where are you experiencing pain?* This field is required.
Back
Neck
Headache/Migraine
2
How long have you had pain?* This field is required.
3-5 days
1-3 weeks
1-3 months
6 months to a year
More than a year
3
On a scale of 1 to 10, how bad is your pain?* This field is required.
1-3
4-6
7-10
4
How many days each week does pain prevent you from doing your favorite activities?* This field is required.
1-2
3-5
6-7
Should be Empty:

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