Are you looking for relief?
Take a brief survey now to see if the Headache Freedom Center could accept your case. 

Address

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* 1. Address

Please check all that apply.
I am currently suffering with:

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* 2. Please check all that apply.
I am currently suffering with:

Regarding the duration of your illness:

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* 3. Regarding the duration of your illness:

Regarding the severity of your illness:

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* 4. Regarding the severity of your illness:

Regarding the impact to my quality of life:

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* 5. Regarding the impact to my quality of life:

Regarding my location and ability to follow through with treatment:

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* 6. Regarding my location and ability to follow through with treatment:

Regarding my financial status and ability to cover the costs of my care:

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* 7. Regarding my financial status and ability to cover the costs of my care:

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