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214-271-4585
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Request Appointment
214-271-4585
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Referred Pain
Referred Pain Guide
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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:
*
Best Time to Call:
Morning
Midday
Afternoon
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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
214-271-4585
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