| Nerve and Joint History: | Yes / No | 
| Do you have frequent headaches? | N | 
| Have you ever had convulsions? | N | 
| Have you had headaches awaken you? | N | 
| Do you have dizziness when turning your head? | N | 
| Do you have muscle pain? | N | 
| Do you have joint pain? | Y, This past weekend in ankles and knees | 
| Do you have ringing in your ears? | N | 
| Are you ever light headed? | N | 
| Do you have any numbness anywhere? | N |