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What is my body trying to tell me

This questionnaire helps us gather important details about your pain or discomfort. Your responses may help us identify possible causes and provide general guidance to improve your pain, but do not replace professional medical advice or assessment.

Where do you most often feel pain or discomfort?

Where do you most often feel pain or discomfort?

How would you best describe the discomfort?

How would you best describe the discomfort?

How long have you been experiencing this issue?

How long have you been experiencing this issue?

On most days, how would you rate your pain on a scale of 1-10?

On most days, how would you rate your pain on a scale of 1-10?

When do you notice your pain or discomfort the most?

When do you notice your pain or discomfort the most?

Did your pain or discomfort begin following an event?

Did your pain or discomfort begin following an event?

If so, tell us a bit about what happened?

Does anything relieve your symptoms? Even temporarily?

Does anything relieve your symptoms? Even temporarily?

Has this affected your daily activities?

Has this affected your daily activities?

What would you most like help with?

What would you most like help with?

Contact Details

Please provide contact details if you wish to be contacted to see how we could help woth your pain.

First Name

Last Name

Phone

Email

By submitting this questionnaire, you are consenting to RDM Osteopathy contacting you regarding a complimentary phone consultation. Please select your preferred method of communication.

By submitting this questionnaire, you are consenting to RDM Osteopathy contacting you regarding a complimentary phone consultation. Please select your preferred method of communication.