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Get Az Apex Pain Specialists Follow-up Patient Medical History Intake Form 2010-2024

: What problem/issue brings you here today? Since your last physician visit, are your symptoms: Better Worse Unchanged Have you undergone any treatment since last visit? Was it helpful? 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.

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