Why not save money AND have less pain?

Are you experiencing migraines, headaches or pain?
Fill out this survey now and receive a $100 CREDIT applied to your headache treatment plan.

* 1. Address

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

* 3. Regarding the duration of your illness:

* 4. Regarding the severity of your illness:

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

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

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