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Pain Assessment Quiz

Is Chiropractic or Acupuncture Right for You?

Take Our 60-Second Pain Assessment Quiz

"*" indicates required fields

Step 1 of 10

10%

What is the level of pain you are experiencing?*

(10 being the most severe)

Where is the source of your pain?*

Headache

Neck

Shoulders

Arms

Back

Legs

Knees

Feet

Other

(Check all that apply)

What type of doctors have you seen for your pain?*

Chiropractor

Pain Management

Neurologist

Orthopedic Surgeon

General/Family Doctor

Other

None

(check all that apply)

What medications or treatments are you receiving for your pain?

Chiropractic Treatment

Physical Therapy

Acupuncture

Opioid Pain Medication

Muscle Relaxants

NSAID

Other/Unsure

None

(Check all that apply)

How did the pain begin?*

Accident at Home

Vehicle Accident

Accident at Work/Work Related

'Just Begin'

After Surgery

'Came on Gradually'

After an Illness

Sports Related

Other

(Check all that appy)

Have you had any of the following treatments/procedures?*

Epidural Steroid Injection

Joint Injection

Trigger Point Injection

Nerve Block

Percutaneous Discectomy

None Of The Above

(Check all the apply)

Have you had any of the following tests for this condition?*

MRI

CAT Scan

EMG

Other Test Not Listed

None

(Check all that may apply)

Have you had any surgeries related to your existing pain or any prior pain conditions?*

Yes

Do you have any type of health or medical insurance?*

Yes

Do you have any additional information about your pain you want us to know or any questions about treatment options we can help answer?

What is your email?*

(Used only to send treatment qualification information)

What is your name?*

First Last

Verify your phone number?*

Last Question. What is your Zip Code*

7108

60-second Pain Assessment Quiz

Step 1: Discover

It all starts with our 60-second Pain Assessment Quiz. Tell us about the pain and discomfort you are experiencing to see that treatment options work for you.

60-second Pain Assessment Quiz

Personalized Care Plan

Step 2: Plan

Together, we'll create a treatment plan personalized to your needs. You will get the honest advice you deserve, complete with available treatments, pricing, options, and more.

60-second Pain Assessment Quiz

Partners in Treatment

Step 3: Treatment

After discussing your options, we will help you choose the fastest, most cost-efficient treatment plan to address your pain and discomfort so you can start living a pain-free life.

Northfield, MN Chiropractors

Cannon Pointe Chiropractic
1040 MN-3
Northfield, MN 55057

Dr. Jacob M. Conway, DC

Dr. Bridget Conway, DC

507-645-8000 - Office

507-645-4400 - FAX