New England Regional
Headache Center, Inc.

 

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Downloadable Headache Diaries and Patient Forms


 All our forms for your convenience are located on our website. Please follow the directions below to help you gain access to important Patient Registration and Headache Diaries.

 Track your medications

Download our monthly management diary to prepare for a discussion with your doctor about your pain and medication use.


It is important to keep headache diaries to help us diagnosis your headaches and provide appropriate treatment plans.

Fill in and print out the registration forms, consent form and headache diaries.

Print or enter daily headache scores to forms in Adobe Acrobat format (*.pdf files) or in electronic Excel spreadsheet formats.

Download the printable diary (NERHC HA diary 2013.pdf) and its instruction sheet Print them out and fill them out daily to bring to your office appointments.

Download the electronic diary (Headache Journal rev5.xls) and record your headaches daily in an Excel electronic spreadsheet. To record symptoms, highlight the daily symptoms in the checklist, hold down the CTRL key and click with the left mouse button on each symptom which you wish to highlight. Then click on the Fill Color icon, choose a color and click to select. All the selected cells will be highlighted with the chosen color. Print out the spreadsheet before your appointment and bring to the office, or bring it on a memory stick or other media. Floppy disks cannot be read in the office.

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Printable Forms  Electronic Forms File Date
     
Headache Journal rev5.pdf Headache Journal rev6.xls March 18 2013
Consent form.pdf Consent form.doc Jan 17 2010
Medication History Form.pdf Medication History Form.doc Jan 17 2010
NP registration.pdf NP registration.doc Jan 17 2010
    Apr 29 2008
     
     
     



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Call Us for More Information at 508 890-5633.

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