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Copyright 1991 Charles S. Cleeland, PhDPain Research GroupAll rights reservedPLEASE USEBLACK INK PENSubject's Initials : ________________PI: ________________________________________ Protocol #: _________________________________Study Name: ________________________________________ ___________________________________Revis ion: 07/01/05PI: ________________________________________ Protocol #: _________________________________Study Name: ________________________________________ ___________________________________Revis ion: 07/01/05(month)(day)(year)(month)(day)(y ear) Date: Study Subject #:1. Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today?
Copyright 1991 Charles S. Cleeland, PhD Pain Research Group All rights reserved PLEASE USE BLACK INK PEN Subject's Initials : _____ PI: _____ Protocol #: _____
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