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Barbell Medicine Pain & Rehab Inquiry Form
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Email *
Date
MM
/
DD
/
YYYY
Name *
Please provide background about yourself and any current issue(s) you’ve been dealing with.
How old are you? *
What is your profession? *
What seems to be the issue? *
Do you have any pre-existing conditions we should be aware of? *
Currently taking any medications? Over the counter supplements? *
Has this issue occurred previously? *
What have you done for this issue previously and/or currently? *
If you've been evaluated for this by another professional, what have you been told about it?
Do you currently exercise? If so, what has your recent (3-6 weeks) training regime consisted of? Please be as detailed as possible (include details such as number of training days, exercises, sets, reps, load, recovery days/methods, etc.). *
What exercise equipment do you have access to? *
A copy of your responses will be emailed to the address you provided.
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