4-Week Pain Relief Program 8-Week-Pain-Recovery-Program First Name * Last Name * Phone Email * Zip Code What caused your pain in the first place? Did the pain start suddenly or gradually? How long have you had the pain? How are you currently managing the pain? Is there anything that reduces or stops the pain? What pain medications past or present have you tried? On a scale of 1-10, with 10 being the worst pain possible. What is your pain level?