Holistic Pain Management Preferences Survey
Help us understand your pain management experiences and preferences for holistic therapies.
Full Name
First Name
Last Name
Email Address (optional)
example@example.com
Where do you experience pain most frequently?
*
Please Select
Back
Neck
Joints (knees, hips, etc.)
Head (migraines, tension)
Muscles
Other
How long have you been experiencing this pain?
*
Less than 1 month
1-6 months
6 months to 1 year
More than 1 year
How would you rate the severity of your pain?
*
No pain
1
2
3
4
5
6
7
8
9
Worst possible pain
10
1 is No pain, 10 is Worst possible pain
Which pain management methods are you currently using? (Select all that apply)
*
Prescription medication
Over-the-counter medication
Physical therapy
Massage therapy
Acupuncture
Meditation/mindfulness
Dietary changes
Other
How open are you to trying holistic or alternative pain management approaches?
*
Very open
Somewhat open
Not sure
Not open
Which holistic therapies are you most interested in trying? (Select all that apply)
Acupuncture
Chiropractic care
Yoga or stretching
Massage therapy
Herbal remedies
Meditation/mindfulness
Other
What barriers or concerns do you have about holistic pain management?
Submit Survey
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