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Dr. Nguyen's Pain Quiz
Please complete the survey below. The doctor looks forward to seeing you at the webinar!
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Full Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
On a scale of 1 - 10, with 10 being the highest, how much does your pain interfere with the quality of your life?
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Least Interference
1
2
3
4
5
6
7
8
9
10
Highest Interference
Are you actively doing anything to manage your pain?
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Yes
No, just "living with it"
Other:
What is the "cause" of your pain?
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Neuropathy due to diabetes
Neuropathy due to other or unknown causes
Age or bad genetics
Sports injury
Car accident
Excess Weight
Other:
I would like a doctor coach who:
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Understands my goals and situation
Creates a plan of action for me so I can see the "path" to getting knee pain relief
Uses natural solutions whenever possible
Holds me accountable
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