Pain Annotation (Eng + Mandarin)

Name:
姓名:

NRIC No:
身份证号码:

Contact No:
联络号码:

Please indicate with an X on these figures where your main path is. Shade any area where your pain spreads. Please number (2, 3 ,4 etc).
请在这些图上用X标明您疼痛的主要区域。用阴影覆盖您疼痛蔓延的区域。请编号（2,3,4,等等)

Thank you for completing this questionnaire. It will help us understand your pain problems. By Signing, you give permission for Singapore Paincare Center to discuss your pain problems with other professionals, and to receive any information relevant to your pain management or our marketing information.
感谢您填写这份调查问卷。它将能够帮助我们了解您的疼痛问题。在上面签字则表示您允许疼痛管理诊所与其他专业人士讨论您的疼痛问题，并且愿意接收任何与您的疼痛管理相关以及其他市场营销的信息。