Basic details so I can reach you and put your case in context.
Repeated movements or sustained postures in a normal day
The positions your body spends the most time in, and the movements it repeats most. This is often where the problem is built.
Current activity level
Mostly sedentary Lightly active
Train 1 to 3 times a week Train 4+ times a week
Competitive athlete
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Where the problem is, and how it began.
Any secondary areas that also bother you
How long has it been there *
Select...
Less than 2 weeks 2 to 6 weeks
6 weeks to 3 months 3 to 6 months
6 to 12 months More than a year Years, comes and goes
Please choose a duration.
Since it started it has been *
Select...
Getting steadily worse About the same
Slowly improving Comes and goes in episodes
Please choose one.
What were you doing when it started *
The mechanism matters more than the label. Describe the movement, the load and the direction if you can.
Please describe how it started.
Has this happened before?
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How the symptoms behave tells me far more than how intense they are.
What makes it worse *
Name the movements, positions and loads, and how quickly the symptoms come on.
Please describe what aggravates it.
Once aggravated, how long to settle
Seconds once I change position A few minutes
An hour or so Several hours Into the next day
Does it travel anywhere
No, it stays in one place
Spreads locally around the area
Travels down the arm
Travels down the leg
Travels past the elbow or knee
What makes it better *
Please describe what eases it.
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This section is a safety screen. It exists to catch the small number of presentations that need a medical doctor rather than a physiotherapist. Please answer honestly, and tick nothing if none apply.
Existing medical conditions
Current medications
Previous surgeries or fractures
Diagnosis or imaging results so far
Treatment tried so far, and whether it helped
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Pain scores move slowly. What you can actually do is the better measure, so we set that baseline now and re-score it as we go.
Name up to three activities this problem makes difficult *
Be specific and everyday. Rate each one from 0 (cannot do it at all) to 10 (no trouble at all).
What would a successful recovery look like for you *
Please tell me what success looks like.
Anything else I should know
I confirm the information above is accurate to the best of my knowledge. I understand this form is an intake, not a diagnosis, and that a physiotherapy assessment does not replace medical care from a doctor.
Please confirm before submitting.
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The Injury Evaluation is 1.000.000 VND ($37.97) and includes a full kinetic movement assessment, a kinetic diagnosis and a corrective plan. Your health details stay confidential per the Privacy Policy .