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Get Az Apex Pain Specialists New Patient Medical History Intake Form 2019-2024

Where is your pain? When did it start? Was there a cause? Please make a mark on the line below to indicate the level of discomfort you have today No Pain 0 1 2 3 4 5 6 7 8 9 Worst Pain Ever 10 Please describe what the pain feels like: Dull Sharp Shooting Achy Stabbing Burning Throbbing Cold Crampy Tingling Numbness Please draw where you have pain or discomfort Tight Please descr.

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