Migraine Health Test | New Leaf Wellness

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Migraines Test

Welcome to our Migraine Test and the start of your Wellness Journey!

Let’s take a few moments to answer some questions about your symptoms and you will have a quick response in your email. You will receive an initial email to confirm your email address, please click on the Opt In to receive our emails.

Contact Information

Please enter the following info so we can properly assess your submission and provide you with information. (* indicates a required field)

First Name *

Last Name

Email *

Primary Phone

Nearest location? *

How did you hear about us? *

Migraine Health Questions

This test is a self-assessment only and should not be used or construed as medical advice or diagnosis.

Do you notice your migraines caused by a "trigger"? *

Yes No

Do you suffer from migraines more than 3x per month? *

Yes No

Do your migraines come from the front/side of your head? *

Yes No

Do you have an "aura" before or with your migraine? *

Yes No

Do migraines prevent normal activity 3 days per month? *

Yes No

Do your migraines last more than 3 hours? *

Yes No

Do your migraines make you feel nauseated? *

Yes No

Does light bother you even when not having a migraine? *

Yes No

From 1 to 10 (10 being the worst), rank your migraine pain *

Comments or Questions?

Congratulations! Let’s take a few moments to answer some questions about your symptoms and you will have a quick response in your email.

Contact Information

Please enter the following info so we can properly assess your submission and provide you with information. (* indicates a required field)

First Name *

Last Name

Email *

Primary Phone

Nearest location? *

How did you hear about us? *

Migraine Health Questions

This test is a self-assessment only and should not be used or construed as medical advice or diagnosis.

Do you notice your migraines caused by a "trigger"? *

Yes No

Do you suffer from migraines more than 3x per month? *

Yes No

Do your migraines come from the front/side of your head? *

Yes No

Do you have an "aura" before or with your migraine? *

Yes No

Do migraines prevent normal activity 3 days per month? *

Yes No

Do your migraines last more than 3 hours? *

Yes No

Do your migraines make you feel nauseated? *

Yes No

Does light bother you even when not having a migraine? *

Yes No

From 1 to 10 (10 being the worst), rank your migraine pain *

Comments or Questions?

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