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Patient Information

*Please provide your full legal name as it appears on your driver's license, state identification card, or government issued identification card.
 
 
* Required information * Información requerida

Oswestry Back Pain Questionnaire Cuestionario de Oswestry Sobre el Dolor de Espalda

*Pain Intensity *Intensidad del Dolor

 

*Personal Care *Cuidado Personal

 

*Lifting *Al Levantar Objectos

 

*Walking *Al Caminar

 

*Sitting *Al Sentarse

 

*Standing *Al Estar de Pie

 

*Sleeping *Al Dormir

 

*Sex Life *Vida Sexual

 

*Social Life *Vida Social

 

*Traveling *De Viaja

 

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