Tell Us About Your Pain Please enable JavaScript in your browser to complete this form.CONDITION CHECK TOOL - Step 1 of 3Where is your pain? (choose all that apply) *ArmsButtocksLegsLower BackMiddle BackNeckShouldersWhere is the pain strongest? *ArmsButtocksLegsLower BackMiddle BackNeckShouldersHow long have you been experiencing pain? *1 month or less1 - 6 months6 - 12 months1 year or moreHow would you describe your pain symptoms? *NoneSharpBurningCrampingNumbness & TinglingRadiating (throbbing)Shocking (quick jolts of pain)Are you always in pain? *Yes, I am in constant pain which worsens depending on which activity I am doingNo, it comes and goes depending on which activity I'm doing or which position I'm inNextWhen is your pain at its worst? *In the morning after waking upWhile standing or walkingWhile bending backwardsWhile sittingWhile lying downWhile performing strenuous activityWhen does your pain feel better? *In the morning after waking upWhile standing or walkingWhile bending backwardsWhile sittingWhile lying downWhile performing strenuous activityNextName *FirstLastPhoneEmail *Please feel free to add any additional information as you see fitSubmit
