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The first step to recovery is to describe your pain.

TAKE OUR BRIEF PAIN ASSESSMENT QUIZ BELOW

Step 1 of 5

20%

Tell Us About Your Pain
Where does it hurt?*
Choose all that apply:
- Lower Back
- Middle Back
- Neck
- Shoulders
- Arms
- Buttocks
- Legs
- Other
Where Is the Pain Strongest?*
- Lower Back
- Middle Back
- Neck
- Shoulders
- Arms
- Buttocks
- Legs
- Other
How Long Have You Been Experiencing Pain:*
- 1 month or Less
- 1-6 months
- 7-12 months
- 1 year or more

Describe Your Pain for Us
How would you describe your pain?
- Sharp
- Burning
- Cramping
- Throbbing
- Quick Jolts of Pain
Are you always in pain?*
- Yes, I am in constant pain that worsens depending on what activity I am doing.
- No, it comes and goes depending on what activity I am doing.
Do you have any of the following Symptoms?
- Pins and Needles Feeling
- Numbness
- Tingling Sensations
- Progressing Weakness
- Loss of Coordination
- None

Tell Us About Your Past Treatment
Have you undergone any of the following?
- CT Scan
- MRI
- X-Ray
- Nerve Conduction Study
- Other (Please Explain)
- None
Other Explanation

What’s your insurance plan?*
- Horizon
- United Healthcare
- Empire
- Anthem
- Cigna
- Aetna
- Oxford
- AmeriHealth
- Other
If other, please tell us about your insurance plan:

First Name*
Last Name*
Email*
Phone*
Best Time to Call:*
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Dallas Location

Craig C. Callewart, MD PA
9101 N. Central Expressway,
Suite 360
Dallas TX 75231
Phone: 214-271-4585

addison Location

Craig C. Callewart, MD PA
17051 Dallas Parkway,
Suite 420
Addison TX 75001
Phone: 214-271-4585

East Texas - forney Location

Craig C. Callewart, MD PA
325 N FM 548,
Suite 100
Forney, TX 75126
Phone: 214-271-4585

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