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	<title>Fresno Fibromyalgia Doctor - Dr. Robert Boydston D.C. &#187; Questions</title>
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	<link>http://fresnofibromyalgiadoctor.com</link>
	<description>Fresno&#039;s Leading Fibromyalgia Doctor - Brain Based and Metabolic Fibromyalgia Treatment</description>
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		<title>Questions</title>
		<link>http://fresnofibromyalgiadoctor.com/questions/</link>
		<comments>http://fresnofibromyalgiadoctor.com/questions/#comments</comments>
		<pubDate>Fri, 28 May 2010 15:50:24 +0000</pubDate>
		<dc:creator>robertboydston</dc:creator>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[Answer Questions]]></category>
		<category><![CDATA[Business Day]]></category>
		<category><![CDATA[Fibromyalgia]]></category>
		<category><![CDATA[Phone Consultation]]></category>
		<category><![CDATA[Questionnaire]]></category>
		<category><![CDATA[Suitability]]></category>

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		<description><![CDATA[Pre-Consultation Fibromyalgia Questionnaire The purpose of the Free Pre-Examination Phone Consultation is to determine if your qualify for our Fibromyalgia Neuro-Metabolic Solutions Program, meaning we want to see if we think we can help you. Please answer all questions as truthfully as possible and do not leave any questions unanswered, as they are going to [...]]]></description>
			<content:encoded><![CDATA[<h1 class="style1 style4"><span style="font-size: 36px;">Pre-Consultation Fibromyalgia Questionnaire</span></h1>
<p><span class="style3">The purpose of the <em>Free Pre-Examination Phone Consultation</em> is to determine if your qualify for our Fibromyalgia Neuro-Metabolic Solutions Program, meaning we want to see if we think we can help you. Please answer all questions as truthfully as possible and do not leave any questions unanswered, as they are going to used in the determination of your suitability for our program. </span></p>
<p>When asked to rate your symptoms on a scale of 0 to 10, &#8220;0&#8243; means that you have not had that symptom the past month and &#8220;10&#8243; means that symptom has been severe the past month.</p>
<p><strong>Remember to rate your symptoms over the past MONTH.</strong></p>
<p><strong><br />
</strong></p>
<p><span class="style3"><strong>
                <div class='gform_wrapper' id='gform_wrapper_2' style='display:none'><form method='post' enctype='multipart/form-data' id='gform_2' class='' action=''>
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                            <ul id='gform_fields_2' class='gform_fields top_label'><li id='field_2_70' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_1' class='gfield    formyellow' ><label class='gfield_label' for='input_2_1'>Name<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_2_1'><span id='input_2_1_3_container' class='ginput_left'><input type='text' name='input_1.3' id='input_2_1.3' value='' tabindex='1' /><label for='input_2_1.3'>First</label></span><span id='input_2_1_6_container' class='ginput_right'><input type='text' name='input_1.6' id='input_2_1.6' value='' tabindex='2' /><label for='input_2_1.6'>Last</label></span></div></li><li id='field_2_71' class='gfield' ><label class='gfield_label' for='input_2_71'>Phone<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_71' id='input_2_71' type='text' value='' class='medium' tabindex='3'  /></div></li><li id='field_2_3' class='gfield' ><label class='gfield_label' for='input_2_3'>Email<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_3' id='input_2_3' type='text' value='' class='medium' tabindex='4'  /></div></li><li id='field_2_4' class='gfield' ><label class='gfield_label' for='input_2_4'>Location (City, State)<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_4' id='input_2_4' type='text' value='' class='medium' tabindex='5'  /></div></li><li id='field_2_47' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_8' class='gfield' ><label class='gfield_label' for='input_2_8'>1. Pain: Have you experienced widespread pain for more than three months?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_8'><li class='gchoice_8_0'><input name='input_8' type='radio' value='Yes'  id='choice_8_0' tabindex='6'  onclick='gf_apply_rules(2,[9]);' /><label for='choice_8_0'>Yes</label></li><li class='gchoice_8_1'><input name='input_8' type='radio' value='No'  id='choice_8_1' tabindex='7'  onclick='gf_apply_rules(2,[9]);' /><label for='choice_8_1'>No</label></li></ul></div></li><li id='field_2_9' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_9'> If so, how intense has your pain been on average?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_9' id='input_2_9'  class='small gfield_select' tabindex='8' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_48' class='gfield  gsection  sectionborder' ><h2 class='gsection_title'></h2></li><li id='field_2_25' class='gfield' ><label class='gfield_label' for='input_2_25'>2. Fatigue: Do you have a problem with fatigue?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_25'><li class='gchoice_25_0'><input name='input_25' type='radio' value='Yes'  id='choice_25_0' tabindex='9'  onclick='gf_apply_rules(2,[24]);' /><label for='choice_25_0'>Yes</label></li><li class='gchoice_25_1'><input name='input_25' type='radio' value='No'  id='choice_25_1' tabindex='10'  onclick='gf_apply_rules(2,[24]);' /><label for='choice_25_1'>No</label></li></ul></div></li><li id='field_2_24' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_24'>If so, how tired have you been?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_24' id='input_2_24'  class='small gfield_select' tabindex='11' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_49' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_10' class='gfield' ><label class='gfield_label' for='input_2_10'>3. Stiffness: Do you have morning stiffness that lasts longer than 15 minutes?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_10'><li class='gchoice_10_0'><input name='input_10' type='radio' value='Yes'  id='choice_10_0' tabindex='12'  onclick='gf_apply_rules(2,[11]);' /><label for='choice_10_0'>Yes</label></li><li class='gchoice_10_1'><input name='input_10' type='radio' value='No'  id='choice_10_1' tabindex='13'  onclick='gf_apply_rules(2,[11]);' /><label for='choice_10_1'>No</label></li></ul></div></li><li id='field_2_11' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_11'>If so, how how bad has your stiffness been?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_11' id='input_2_11'  class='medium gfield_select' tabindex='14' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_50' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_12' class='gfield' ><label class='gfield_label' for='input_2_12'>4. Headaches: Have you had more than one or two headaches the past month? <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_12'><li class='gchoice_12_0'><input name='input_12' type='radio' value='Yes'  id='choice_12_0' tabindex='15'  onclick='gf_apply_rules(2,[13]);' /><label for='choice_12_0'>Yes</label></li><li class='gchoice_12_1'><input name='input_12' type='radio' value='No'  id='choice_12_1' tabindex='16'  onclick='gf_apply_rules(2,[13]);' /><label for='choice_12_1'>No</label></li></ul></div></li><li id='field_2_13' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_13'>If so, how intense have your headaches been?</label><div class='ginput_container'><select name='input_13' id='input_2_13'  class='small gfield_select' tabindex='17' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_51' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_14' class='gfield' ><label class='gfield_label' for='input_2_14'>5. Sleep Disturbance : Do you have trouble sleeping? <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_14'><li class='gchoice_14_0'><input name='input_14' type='radio' value='Yes'  id='choice_14_0' tabindex='18'  onclick='gf_apply_rules(2,[15,16]);' /><label for='choice_14_0'>Yes</label></li><li class='gchoice_14_1'><input name='input_14' type='radio' value='No'  id='choice_14_1' tabindex='19'  onclick='gf_apply_rules(2,[15,16]);' /><label for='choice_14_1'>No</label></li></ul></div></li><li id='field_2_15' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_15'>If so, how disturbed has your sleep been?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_15' id='input_2_15'  class='small gfield_select' tabindex='20' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_16' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_16'>Do you have trouble falling asleep or staying asleep, or both ?</label><div class='ginput_container'><select name='input_16' id='input_2_16'  class='medium gfield_select' tabindex='21' ><option value='Falling Asleep' >Falling Asleep</option><option value='Staying Asleep' >Staying Asleep</option><option value='Both' >Both</option></select></div></li><li id='field_2_52' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_17' class='gfield' ><label class='gfield_label' for='input_2_17'>6. Bowel Disturbance : Do you have bowel or digestive problems?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_17'><li class='gchoice_17_0'><input name='input_17' type='radio' value='Yes'  id='choice_17_0' tabindex='22'  onclick='gf_apply_rules(2,[18]);' /><label for='choice_17_0'>Yes</label></li><li class='gchoice_17_1'><input name='input_17' type='radio' value='No'  id='choice_17_1' tabindex='23'  onclick='gf_apply_rules(2,[18]);' /><label for='choice_17_1'>No</label></li></ul></div></li><li id='field_2_18' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_18'>If so, how disturbed has your bowel function been?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_18' id='input_2_18'  class='small gfield_select' tabindex='24' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_53' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_19' class='gfield' ><label class='gfield_label' for='input_2_19'>7. Depression or Anxiety : Have you had trouble with depression or anxiety?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_19'><li class='gchoice_19_0'><input name='input_19' type='radio' value='Yes'  id='choice_19_0' tabindex='25'  onclick='gf_apply_rules(2,[20]);' /><label for='choice_19_0'>Yes</label></li><li class='gchoice_19_1'><input name='input_19' type='radio' value='No'  id='choice_19_1' tabindex='26'  onclick='gf_apply_rules(2,[20]);' /><label for='choice_19_1'>No</label></li></ul></div></li><li id='field_2_20' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_20'>If so, how depressed or anxious have you been?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_20' id='input_2_20'  class='small gfield_select' tabindex='27' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_54' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_21' class='gfield' ><label class='gfield_label' for='input_2_21'>8. Memory &amp; Concentration: Have you had problems with your memory or concentration?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_21'><li class='gchoice_21_0'><input name='input_21' type='radio' value='Yes'  id='choice_21_0' tabindex='28'  onclick='gf_apply_rules(2,[22]);' /><label for='choice_21_0'>Yes</label></li><li class='gchoice_21_1'><input name='input_21' type='radio' value='No'  id='choice_21_1' tabindex='29'  onclick='gf_apply_rules(2,[22]);' /><label for='choice_21_1'>No</label></li></ul></div></li><li id='field_2_22' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_22'>If so, how bad has your memory and/ or concentration been?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_22' id='input_2_22'  class='small gfield_select' tabindex='30' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_55' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_23' class='gfield' ><label class='gfield_label' for='input_2_23'>9. Cold Hands &amp; Feet : Do you have cold hands, feet, or body?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_23'><li class='gchoice_23_0'><input name='input_23' type='radio' value='Yes'  id='choice_23_0' tabindex='31'  onclick='gf_apply_rules(2,[26]);' /><label for='choice_23_0'>Yes</label></li><li class='gchoice_23_1'><input name='input_23' type='radio' value='No'  id='choice_23_1' tabindex='32'  onclick='gf_apply_rules(2,[26]);' /><label for='choice_23_1'>No</label></li></ul></div></li><li id='field_2_26' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_26'> If so, how cold have you been (hands, feet, or whole body)?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_26' id='input_2_26'  class='small gfield_select' tabindex='33' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_56' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_27' class='gfield' ><label class='gfield_label' for='input_2_27'>10. Numbness or Tingling : Do you experience numbness or tingling in your hands or feet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_27'><li class='gchoice_27_0'><input name='input_27' type='radio' value='Yes '  id='choice_27_0' tabindex='34'  onclick='gf_apply_rules(2,[28]);' /><label for='choice_27_0'>Yes </label></li><li class='gchoice_27_1'><input name='input_27' type='radio' value='No'  id='choice_27_1' tabindex='35'  onclick='gf_apply_rules(2,[28]);' /><label for='choice_27_1'>No</label></li></ul></div></li><li id='field_2_28' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_28'> If so, how how bad has this problem been?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_28' id='input_2_28'  class='small gfield_select' tabindex='36' ><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li><li id='field_2_58' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_29' class='gfield' ><label class='gfield_label' for='input_2_29'>11. Have you been diagnosed with fibromyalgia?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_2_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='37'  onclick='gf_apply_rules(2,[31]);' /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='38'  onclick='gf_apply_rules(2,[31]);' /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_2_31' class='gfield' style='display:none;'><label class='gfield_label' for='input_2_31'>What year, and by what doctor were you diagnosed?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_31' id='input_2_31' type='text' value='' class='large' tabindex='39'  /></div></li><li id='field_2_59' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_32' class='gfield' ><label class='gfield_label' for='input_2_32'>12. How long do you think you&#039;ve suffered with fibromyalgia symptoms?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_32' id='input_2_32' type='text' value='' class='large' tabindex='40'  /></div></li><li id='field_2_60' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_33' class='gfield' ><label class='gfield_label' for='input_2_33'>13. How has your life changed since fibromyalgia became a problem?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_33' id='input_2_33' class='textarea medium' tabindex='41'  rows='10' cols='50'></textarea></div></li><li id='field_2_61' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_36' class='gfield' ><label class='gfield_label' for='input_2_36'>14. Since you&#039;ve suffered from fibromyalgia, what three things have you missed doing the most?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_36' id='input_2_36' class='textarea medium' tabindex='42'  rows='10' cols='50'>1. 

2. 

3. </textarea></div></li><li id='field_2_66' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_45' class='gfield' ><label class='gfield_label' for='input_2_45'>15. What Are Your Top 2 Questions You Would Like Dr. Boydston To Answer In The 10 Minute Consultation?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_45' id='input_2_45' class='textarea medium' tabindex='43'  rows='10' cols='50'></textarea></div></li><li id='field_2_74' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_46' class='gfield' ><label class='gfield_label' for='input_2_46'>16. Why do you think that you would be a good candidate for our program? <span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_46' id='input_2_46' class='textarea medium' tabindex='44'  rows='10' cols='50'></textarea></div></li><li id='field_2_75' class='gfield  gsection' ><h2 class='gsection_title'></h2></li><li id='field_2_73' class='gfield' ><label class='gfield_label' for='input_2_73'>17. How Committed Are You To Getting Into The Program and Reversing Your Fibromyalgia? (on a scale of 1-10, with 1 being little committment and 10 being full committment)</label><div class='ginput_container'><select name='input_73' id='input_2_73'  class='medium gfield_select' tabindex='45' ><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option></select></div></li>
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<p><span class="style3"><strong>After your responses are reviewed we will call you to assign you the next available phone consultation. Expect a call in approximately 1 Business Day. </strong></span></p>



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