Name (required) Email (required) Contact (required) Question 1: Does your pain have one or more of the following characteristics? BurningCold is painfulElectric Shocks Question 2: Is the pain associated with one or more of the following symptoms in the same area? TinglingPins and needlesNumbnessItching Question 3: Is the pain located in an area where you feel one or both of the following characteristics? decreased sensitivity to touchdecreased sensitivity to pinprick Question 4: Do you feel that the pain is caused or increased by: light touch Thank You for completing this questionnaire to let us better understand your pain. We respect and keep your data safe. In accordance with the Personal Data Protection Act (PDPA) of Singapore, I consent the sharing of my medical records within Singapore PainCare Center as well as other health care providers for any investigations, treatments and other healthcare purposes if necessary. (Examples: Hospitals, Imaging Centers, Physio Centers, etc) I consent to receive marketing updates and educational information from Singapore Paincare Center.
