Nerve Block Result Form

Patient Name(*)
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Patient Email(*)
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What degree of pain relief did you have, if any?(*)

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How did you tolerate the numbness in the injected areas? (*)
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Were you able to engage in any provocative maneuvers?(*)
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If so, what were they and how did they affect your relief/numbness?(*)
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How Long Did the Nerve Blocks Last?(*)
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Any Other Feedback?(*)
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WORKING HOURS

Monday 9:00 am - 5:00 pm
tuesday 9:00 am - 5:00 pm
wednesday 9:00 am - 5.00 pm
thursday 9:00 am - 5:00 pm
friday 9:00 am - 5:00 pm

SAN FRANCISCO

  • 2100 Webster Street, Suite 109, San Francisco, CA 94115
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  • 415-751-0583
  • 415-751-6814

WALNUT CREEK

  • 100 N Wiget Ln #160, Walnut Creek, CA 94598
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  • 925-933-5700
  • 415-751-6814

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