ASSESS YOUR PAIN

1Tell us where it hurts

Show us where you hurt
Body Pain

Lower Back

Middle Back

Neck

Shoulders

Arms

Buttocks

Legs

How long have you been experiencing pain?

2Describe your pain

How would your describe your pain?
Happy Face
Straight Face
Sad Face
Pain Face

3Tell us more about your symptoms

What caused your pain originally?
Do you have any of the following symptoms?

4Tell us about your past treatment

Have you undergone any of the following?
If other, please explain:

5Get your results

Tell us about you
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