Nerve and Joint History:

Yes / No

Do you have frequent headaches?

N

Have you ever had convulsions?

N

Have you had headaches awaken you?

N

Do you have dizziness when turning your head?

N

Do you have muscle pain?

N

Do you have joint pain?

Y, This past weekend in ankles and knees

Do you have ringing in your ears?

N

Are you ever light headed?

N

Do you have any numbness anywhere?

N


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