Curonix Candidate Assessment

Eight Questions. Less Pain. More Living.

Answer eight questions below, and our interactive assessment tool will provide insight into
your candidacy for Freedom from Chronic Pain

Contact Information:
I am completing this candidate assessment for?
Please select you or your friend/family member's gender
How long have you or your friend/family member been suffering from pain?
What type of pain is being experienced? (Select all that apply):
Rate the average daily pain level over the past 30 days.
Which pain treatments have you or your friend/family member tried? (select all that apply)
Does pain keep you or your friend/family member from? (select all that apply):
Which statement best describes you or your friend/family member best?