Please rate your level of pain from 0= No Pain to 10= Unbearable pain

Please rate your level of energy from lots of energy=0 to no energy=10

Please rate your level of stiffness from no stiffness=0 to severe stiffness=10

Please rate the quality of your sleep from woke up well rested=0 to woke up very tired=10

Please rate your level of depression from no depression =o to very depressed=10

Please rate your level of memory problems from good memory=0 to very poor memory=10

Please rate your level of anxiety from not anxious=0 to very anxious=10

Please rate your level of tenderness to touch from no tenderness=0 to extremely tender=10

Please rate your level of balance problems from no imbalance=0 to severe imbalance=10

Please rate your level of sensitivity to loud noises, bright lights, odors and cold from no sensitivity=0 to severe insensitivity=10