You can always press Enter⏎ to continue
Bond Eye Associates - Headache Evaluation
Answer a few questions to find out what might be causing your headache
Get Started
1
How bad is your headache pain?
*
This field is required.
Severe pain
Moderate pain
Previous
Next
Get my results
Press
Enter
2
Is the pain on only one side of your head?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
3
Is the pain on both sides of your head?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
4
Did you recently experience a head injury?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
5
Do you have PMS?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
6
Do you have a cold, the flu, a sinus infection or a hangover?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
7
Are you experiencing pulsing or throbbing pain?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
8
Are you experiencing pressure or a squeezing sensation?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
9
Is your headache brief (under 2 hours) and are you experiencing a sharp or stabbing pain in one eye or feeling restless?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
10
Is your headache long lasting (over 4 hours) and are you experiencing sensitivity to light and sound or experiencing nausea or vomiting?
*
This field is required.
YES
NO
Previous
Next
Get my results
Press
Enter
11
What is your name?
*
This field is required.
First Name
Last Name
Previous
Next
Get my results
Press
Enter
12
What is your phone number?
*
This field is required.
Area Code
Phone Number
Previous
Next
Get my results
Press
Enter
13
What is your email address?
By including your email address, you are providing consent for Bond Eye Associates to send you marketing emails in the future.
example@example.com
Previous
Next
Get my results
Press
Enter
Should be Empty:
Question Label
1
of
13
See All
Go Back
Get my results