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Chronic Pain Survey

Our Chronic Pain Survey is for you to tell us what else you would find useful on our site. If you have come to our site searching for tools or an answer to help you to get out of pain, we would love to hear from you. The only information that is required is your name.

Thank you so much for your time.

Chronic Pain Survey
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name
E-mail Address
Street Address
City
State/Prov
Country
Home Phone
Business Phone
How long have you been in pain?*
>6 months
6 mos-1 year
1-2 yrs
2-5 yrs
5+ yrs
Not in Pain Anymore
Where is the concentration of your pain?*
Neck/Upper Back
Upper Back/Shoulders
Shoulders Radiating Into Arm
Lower Arms/Hands
Mid-Back/Between Shoulder Blades
Lower Back
Lower Back Radiating Into Legs
Legs
Lower Leg/Feet
Is your pain:*
Chronic, Every Day
Intermittent, Don't Know Why
Intermittent After Certain Activities
Once In A While
Resolved
What helps your pain?*
Sleep
Stretching
Massage
Chiropractic
Other Bodywork
Over The Counter Pain Meds
Prescribed Pain Medications
Other
What makes your pain worse?
How many healthcare professionals have you seen for this pain (which profession)?
Do you want to learn more about natural chronic pain solutions?
YES
NO
Did you download a copy of our stretching pdf for chronic muscle restrictions?
YES
NO
What else do you WANT to see on our site?

Please enter the word that you see below.

  





Chronic Pain
Pain Relief for TMJ
Lower Back Pain, Morning Back Pain
Pain Under Shoulder Blades
Carpal Tunnel and Repetitive Strain Injuries of the Forearm
Desk Position Checklist for Chronic Postural Strain
Pain in the Shoulder and Neck Go from Chronic Pain Survey to GTS Home


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"I've been dependent on my chiropractor and massage therapist for years. It all helped, but I feel like someone finally showed me what to do, so that I now know how to help myself. I also found out what I was doing every day to make my lower back pain worse! Thank you for sharing these tools with me." Beth F.

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