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How long have you been experiencing pain? *

less than 6 mo

6 mo - 2 years

2 - 5 years

5 -10 years

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On a scale 1-5 how intense is your pain?

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2 - moderate discomfort

3 - high moderate discomfort

4 - high frequent discomfort

5 - Unmanageable consistent discomfort

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