Request edit access
Movement Improvement: Pre-Screen
This form will give me information on your current injury or issue and allow me to develop a plan of action to assist you in recovery
Best Days/Times to Schedule Session
What is currently bothering you?
Where does it hurt? Specific body part and also which area (ex: inner left leg, closer to knee)
Does the pain/tension refer elsewhere? (Ex: many times back pain can refer down into the hip)
If you answered yes above, where does the pain refer to?
What movements bother it or make the pain worse? What portion of the movement or action causes pain?
What movement does it restrict?
What movements make it feel better?
Does it feel like joint or muscular pain?
Is your flexibility restricted?
Have you had this examined by a doctor?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service