Disclaimer

• The questionnaire you are about to complete is intended as a tool to help your physician or other qualified health professional make a diagnosis and create a treatment plan for you.
• Only a physician can make a diagnosis after taking a history and doing a medical and neurological examination and appropriate testing.
• The answers you give to the questions will be used to generate a clinical impression that should be taken to your physician or other qualified health professional for further evaluation, physical examination and any appropriate testing.