What is your average level of pain?

On a scale from 1 to 10, with 1 representing minimal
and 10 being most severe, rate your personal pain.

1

2

3

4

5

6

7

8

9

10

Where is your pain located?

Choose all areas that apply.

Do you feel some relief when you:

• Lean on
  something

  

• Bend
  forward

  

• Sit
  down

  

Which of the following treatments are you
currently using or have used in the past?

Choose all that apply.

Are you currently being treated by a
pain management specialist?

Pain management specialists are doctors who specialize in all kinds of pain. They receive years of advanced training in pain management and focus on treating patients with severe pain.

My age is Under 35 35-44 45-54 55-64 65 and over I'd rather not say

My gender is Male Female Non-binary I'd rather not say

What type of insurance do you have?

Choose all that apply.

Here’s what you told us.

To make any changes, simply click on the link to your answer below.