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Where is your pain? (Choose all that apply)
How long have you been experiencing pain?
A month or less
One to six months
Seven months to a year
A year or more
How would you describe your pain?
Shocking (quick jolts of pain)
Do you have any of the following symptoms? (choose all that apply)
Pins and needles feeling
Loss of coordination
Are you in constant pain?
When is your pain at its worst?
In the morning after waking up
While standing or walking
While bending backwards
While performing strenuous activities
When does your pain feel better?
What caused your pain originally?
Lifting something heavy
Slip or fall
Have you undergone any of the following tests?
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