Our aim is to give you your life back MHNI
Migraine | Other Head Pain and Neck Pain | Other Pain Disorders    For Immediate Assistance

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(734) 677-6000
(800) 518-3639


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Skip Navigation LinksStudy Application

In general, research projects conducted at MHNI involve individuals who can easily travel to the Institute for evaluation and treatment (generally within 100 miles of Ann Arbor, Michigan) and who fulfill specific enrollment criteria for each study. Please complete the following profile. A Study Nurse will contact you to provide further information.

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Study Application
     
  Describe your pain:    

Frequency:




Average Inensity:



Duration:



Symptoms:


Symptoms (cont):







Descibe any other symptoms you have:


Describe current treatment:
 
 
Tell us about you: 		 
  Courtesy Title:   
  * Full Name:   
  Job Title:   
  * Street Address:   
  Address Part 2:   
  * City:   
  The above address is a:   
  * State:   
  OR * Province:   
  * Zip/Postal Code:   
  * Country:   
  * Daytime Phone:  ()  Ext:   
  Fax:  ()  
  * Email Address:   
  * Confirm Email Address:   

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