Free Nutrition Report
What Our Clients Say
DONNA F. SMITH, C.C.N., C.N.
Licensed, Board Certified
H. BRELAND, P.T., S.C.S.
Board Certified Sports Specialist
ROBERT J. WOLFF, D.C.
T. ROGER HUMPHREY, M.D.
Wichita Falls, Tx
Office (940) 761-4045
Fax (940) 761-2881
The information and services provided
are for nutritional support, and not for the treatment of any medical
condition or disease. By using this web site, you understand and
abide by this disclaimer.
Donna F. Smith
PRINTING INSTRUCTIONS: Print before clicking SEND NOW button. Should
this questionnaire not print entirely in Portrait format, simply click on
the File menu, go to Print, click the "Properties" button.
A new dialog box will open. On the "Paper" tab click the radio
buttion labeled "Landscape", click ok to close the dialog box.
Then click OK to print.
Client Instructions for Completing the Tender Point Test below:
Press on the tender points and mark the spaces below from 1 to 18 with
an A, B, or C, depending upon the degree of pain - mild, moderate or severe.
Key: 11 or more Tender Points. (When you click Total
your answers will automatically be submitted. You can only submit one
form at a time.)
Tender Points for Diagnosis of Fibromyalgia
To print this form, simply highlight/select the form by placing the cursor
before the Date field and dragging to the bottom of the form. Then under
the File menu, go to Print, and under Print range, select the option "Selection".
Then click OK.
Severity Scale: A. Severe Pain B. Moderate Pain C. Mild Pain
Anatomic location of tender points
according to the
American College of Rheumatology
1990 classification criteria for fibromyalgia.
Copyright, 1990 American College of Rheumatology