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Check if You've Had the Following:

Headaches	Chronic Pain
Lower Back pain	Fibromyalgia
Osteoarthritis	Whiplash
Numbness/ tingling	Wrist Pain
Pain with activity	Shoulder Pain
Sciatica

How does it affect you at it's worst?

Moody	Interrupts Sleep
Decreases        Productivity	Lose Patience        with spouse/ children
Irritable	Other

Any Other Questions or Concerns?

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