Headache Survey Headache Survey How long have you been experiencing headaches? Select an option Less than 3 months 3 to 6 months More than 6 months Where do you primarily feel the pain? Select an option Frontal area (forehead) Temples (sides of the head) Base of the skull All over the head What seems to trigger or worsen your headaches? Stress or anxiety Certain foods or drinks Lack of sleep Bright lights or loud noises Do you experience any additional symptoms along with your headaches? Neck stiffness or pain Jaw pain How often do you experience headaches? Select an option Occasional (a few times a month) Frequent (several times a week) Daily How would you describe the intensity of your headaches? Select an option Mild (tolerable) OFFICE HOURS Monday 9:00am - 12:30pm 2:00pm - 6:00pm Tuesday 9:30am - 12:30pm 2:00pm - 6:00pm Wednesday 9:00am - 12:30pm 2:00pm - 6:00pm Thursday 9:00am - 12:30pm 2:00pm - 6:00pm Friday Closed Saturday Closed CLOSURE DATES October 9thNovember 22ndNovember 23rdDecember 25th - January 1st CLOSURE DATES Singer Chiropractic Wellness Center 405 South State College Boulevard #202 Brea, CA 92821 (714) 582-6235
