Fibromyalgia

Interested in participating in a fibromyalgia study?

Fill out the form below to see if you qualify.

First Name*

Last Name*

Email*

Phone Number*


Have you ever been diagnosed with Fibromyalgia?


How long have you been in pain?


​How many places in your body does it hurt?


​Where in your body does it hurt?
 back neck arms legs hands feet other


​Does the pain radiate to your extremities?
 yes no


​​Do you take anything for the pain?
 yes no


​​-If so, how long have you been taking pain medication?


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