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Patient Information
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Select a number for each question below.
What is your overall pain score now? *
What is your pain score when not taking pain medications? *
What is your pain score after taking pain medications? *
How often do you experience pain? *
Do you have any side effects with the medications? *
Have you been experiencing any of these symptoms in the past 2 weeks? (Please Select)
Constitutional
Cardiovascular
Respiratory
Gastrointestinal/GU
Neurological
Other
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