NM Quiz

Which best describes your situation?

Have you or the person you are caring for been
suffering from pain for more than 6 months?

What is your (or the person you are caring for)
average level of pain?

On a scale from 1 to 10, with 1 representing minimal
and 10 being most severe, rate your personal pain.

Where is your (or the person you are caring for) pain located?

Choose all areas that apply.

Front

Back

Which of the following treatments are you
(or the person you are caring for) currently
using or have used in the past?

Choose all that apply.

Are you (or the person you are caring for)
currently being treated by a pain management specialist?

Pain management specialists are doctors who specialise in all kinds of pain. They receive years of advanced training in pain management and focus on treating patients with severe pain.

Month of birth Year of birth

My gender assigned at birth is

First name

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Last name

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Post code

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State

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Email address

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Phone number (include area code and/ or country code)

Please enter a valid phone number with your 3-digit area code and your 7-digit telephone number.

If you are a carer and would prefer all communication and information to be shared with you instead, please provide your contact details below:

Carer name

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Carer Email address

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Carer Phone number (include area code and/ or country code)

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Complete and submit the form below to get access to a guide to discuss with your doctor and enable contact from a Boston Scientific Technical Specialist.

Complete and submit the form below to get access to a guide to discuss with your doctor.