Helpful Forms

 

 

Headache Disability Headache

Allows a measurement of your progress for the treatment of headaches, Trigeminal Neuralgia and Migraines

Fibromyalgia Impact Questionaire

Gives and outcome of your progress for Fibromyalgia

Lower Body Functional Questionaire

Gives an Outcome Measure of your progress for pain in the lower back and legs

Upper Body Functional Questionaire

Measurement Outcome Tool for Progress on the Treatment of Pain in the Upper Back, Neck and Arms.

Intake Form _ Daniel Haun, L.Ac.

Patient's health history, contact and insurance, information, consent to treat, and HICFA

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