3D Spine Simulator


Launch 3D Spine Simulator

Please print & bring this questionaire with you to your visit to find out & discuss your score with our practitioners.
 
Please check off the choice that best describes your Headache Pain.

 

1-Because of my headaches I feel handicapped.
Yes
Sometimes
No

2-No one understands the effect my headaches have on my life.
Yes
Sometimes
No

3-My headaches make me angry.
Yes
Sometimes
No

4-Sometimes I feel that I am going to lose control because of my headaches.
Yes
Sometimes
No

5-My spouse/significant other, or family and friends have no idea what I am going through because of my headaches.
Yes
Sometimes
No

6-My headaches are so bad that I feel I am going to go insane.
Yes
Sometimes
No

7-My outlook on the world is affected by my headaches.
Yes
Sometimes
No

8-I am afraid to go outside when I feel a headache is starting.
Yes
Sometimes
No

9-I feel desperate because of my headaches.
Yes
Sometimes
No

10-My headaches place stress on my relationships with family and friends.
Yes
Sometimes
No

11-I feel irritable because of my headaches.
Yes
Sometimes
No

12-My headaches make me feel confused.
Yes
Sometimes
No

13-My headaches make me feel frustrated.
Yes
Sometimes
No