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Cascade pre-screening

Cascade Headache is a specialty headache, migraine, and facial pain practice. Please answer the questions carefully so we can determine whether we may be a good fit before scheduling.

Submitting this form does not establish a patient-provider relationship or guarantee an appointment. Please keep responses brief and do not send medical records, medication lists, images, or urgent concerns through this form.

Your contact information

First name

Last name

Phone number

Date of birth

A little about what you are looking for

What are your goals that you wish to accomplish in our work together?

What are your current medical conditions? Enter “N/A” if you have no medical history.

How do you expect your medical providers to approach your care?

For example, do you prefer more collaboration or enjoy integrating non-pharmacological approaches?

What impacts are headaches or migraines having on your life currently?

Anything else you would like us to know about you?

Practice information

I understand that Cascade Headache does not currently accept health insurance.

Agree Disagree

How did you hear about us?

By submitting, you confirm that the information above is accurate to the best of your knowledge. This form is not monitored for urgent or emergency concerns.

Cascade pre-screening

Thank you.

Your contact information

A little about what you are looking for

Practice information