Do I Need Physical Therapy? Quiz
This short quiz is designed to present a picture of your current mobility levels and what services you may benefit from by Optimal Recovery & Therapy PLLC. When answering please know there are no right or wrong answers, and your answers will remain private.
Email address *
What is your name? *
How often do you have pain? *
Never
On a Daily Basis
How often do you take pain medication to manage your pain? *
Never
Every Time I Have Pain
How many times have you lost your balance in the past year? *
Zero
Ten or more
How many times have you fallen in the past year? *
Zero
Ten or more
How would you rate your current strength levels? *
Extremely Weak
Extremely Strong
How would you rate your current stress level? *
No Stress
Extremely Stressed
How many times in the past month have you avoided leaving the house or canceled a social engagement because of pain or weakness? *
Zero
Ten or More
How much is your pain, injury, or weakness affecting the time you spend with your family and friends? *
Not at All
A Lot
How much difficulty have you had with daily activities, such as showering, getting dressed, or brushing your teeth? *
None
Extreme Difficulty
How much difficulty have you had with eating, swallowing, speaking, or your memory? *
None
Extreme Difficulty
Would you be willing to participate in a free 15-minute phone or video consultation regarding your quiz results? *
Please provide your phone number for your free consultation
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