First name
Surname
Address
Town/City
County
Postcode
Contact Number
E-mail Address
Do you have arthritis?
What alternative treatments have you tried?
Where specifically is the pain?
On a scale of 1-10 (10 is worst) what is the level of pain?
How long have you had the pain (YY/MM) ?
Is the pain continuous?
What makes the pain worse?
Any other important information?
