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Where is the source of your pain? Choose all options that apply.

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What type of doctors are you interested in? Choose all options that apply.

Chiropractor

Pain Management

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Have you had any surgeries to your existing pain or any other pain condition?

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What areas of your life are affected by the pain? Choose all options that apply.

Maintaining a safe environment

Communication

Breathing

Eating & Drinking

Washing & Dressing

Mobilization

Working & playing

Expressing sexuality

Sleeping

Daily Parenting

Finances

Household chores

Self Worth/Value

Physical well-being

Emotional Health

Other

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