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1. Do you suffer from neck pain ?

Yes
No

2. Do you experience  pain behind your eyes ?

Yes
No

3. Do you experience a pain radiating  to your shoulder or back?

Yes
No

4. Do you experience pain behind your head (occipital)?

Yes
No

5. Do you suffer from  pain while opening the mouth or chewing ?

Yes
No

6.Do you have a recurring pain the head?

Yes
No

7.Do you easily get tired and fatigued in a regular basis ?

Yes
No

8.Do you have a tendency to grind or clench your teeth ?

Yes
No

9.Do you feel dizziness or lightheadedness at random ?

Yes
No

 

 

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