Fibromyalgia/Chronic Fatigue Basic Health Pre-Assessment

  • Fibromyalgia/Chronic Fatigue Basic Health Pre-Assessment

    Please answer the questions below to help determine if you suffer from Fibromyalgia or Chronic Fatigue. Please complete all fields.
  • 1. Do you often suffer chronic fatigue?*
  • 2. Have you had muscle or joint pains more than 3 months?*
  • 3. Do you often have difficulty concentrating or remembering things?*
  • 4. Do you suffer from chronic insomnia?*
  • 5. Do you often awake from your sleep and feel unrefreshed?*
  • 6. Do you suffer from frequent headaches?*
  • 7. Do you experience night sweats?*
  • 8. Do you experience chills?*
  • 9. Do you have recurring sore throats?*
  • 10. Do your glands often feel swollen?*
  • 11. Do you suffer from depression?*
  • 12. Do you have abdominal bloat?*
  • 13. Do you suffer from constipation?*
  • Format: (000) 000-0000.
  • Select the preferred time for a FREE review with a patient representative:*

  • When we receive your results we will place $50.00 on
    your account towards a first visit with us!

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