Do you get head pain in these areas? If so, fill out the details:
(NB "Recent" is <6 months; "Chronic" is >6 months)
Do you have pain or discomfort in any of the following areas? If so, please indicate the approximate date the pain began.
If yes, what were the results of the sleep study?
Does any family member have the same or similar problem? If yes, please explain:
Can you related your pain or condition to a motor vehicle accident or traumatic injury?
Please list the NINE biggest symptoms you have, ranked from number 1 (most severe) to number 9 (least severe).