Pain Survey

Tell us a little about your pain

Please complete our short pain survey, we do not share personal or contact information with anyone. 

Pain Survey

Please identify your chronic pain:
Bone Pain
Cancer Pain
Chronic Regional Pain Syndrome
Circulatory problems
Fibromyalgia
General somatic pain
Migraines
Muscle spasms
Osteo Arthritis
Peripheral neuropathy
Phantom Limb Pain
Rheumatoid Arthritis
Shingles
Spinal Injury
Other
If Other please specify:
What is your age?
Less than 13
13 - 18
19 - 25
26 - 35
36 - 50
Over 50
Please provide your province:
Email:
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