est of your life with the symptoms you have right now, how would you feel about it? (Fill in one circle) OVery dissatisfied °Somewhat dissatisfied ONeutral °Somewhat satisfied OVery satisfied MY PAIN / DISCOMFORT IS: 0 1 2 3 4 1 I I 1 (circle number) I No Pain 5 I 6 7 8 9 10 1 I I