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Pain Questionaire

First Name*

Last Name*

Phone*

Email*

Free Text

Pain Levels

Describe Your Pain

Today*

Good Day*

Bad Day*

Pain Duration

Comes & Goes

Occasional

Frequent

Constant

Improvements

Getting Better

Getting Worse

Staying the Same

No Improvement With Therapy

Symptoms

Forgotten During Activities

Interfere With Activities

Worse With Activities

Prevents Activities

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Location:

6801 Mcpherson Road Suite 334 Laredo, TX 78041

Phone:

Hours:

Mon - Thu : 7:00am - 5:00pm

Fri : 7:00am - 4:00pm

Pain Consultants Of Texas

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