formulario como quitar el dolor cervicaldaniloasturaro2023-03-25T13:53:05+00:00

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Nombre *

Apellido *

Fecha de nacimiento *

email *

Localidad *

Telefono *

Actividad Laboral *

Actividad deportiva hecha *

Motivación Consulta

Tipo de problema *

Síntomas *

Limitaciones funcionales *

Expectativas post tratamiento *

Mapa Corporal

Valor del dolor de 1 a 10 *

Características del dolor *

Impacto funcional *

Comportamiento 24 hs *

Historia previa y reciente

¿Cuándo empezó el problema? *

La evolución del problema *

¿Fué constante en el tiempo o empeoró? *

Tratamientos previos *

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