Posted by Bobby Gilliam on May 30, 1999 at 00:28:19:
In Reply to: Re: Reception/intake posted by Bobby Gilliam on May 30, 1999 at 00:10:45:
Name
Address Optional
Questions (optional)
1. Are you currently having Headaches?
2. Are you currently under a doctors care for Headaches?
3. Are you currently taking any medications of any kind?
A. For Headaches:
B. For other health issues:
4. Have you been diagnosed with a specific type of headache by a doctor?
5. Would you like us to send your current doctor an information packet on Cluster Headaches?
6. Do you need someone to talk to ?
7. What times would you be available for a meeting with a Welcome Guide on the Cluster Headache Chat Line? (List 3 times and be specific).
Time 1
Time 2
Time 3
8. Additional comments or questions?
NOTE Please be patient we are doing all that we can and have CH ourselves. We will answer as quickly as possible.