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Forms and Questionnaires

Pre-participation health screening and Physical Activity Index

Onboarding, Cardiorespiratory Fitness, Programme Onboarding

This tool allows us to ensure that it is safe for you to begin or continue on a exercise programme. We use the gold standard from the American College of Sports Medicine

Detailed Medical History

Onboarding, Programme Onboarding

We are obsessed with finding the root cause of illness or injury so getting a detailed history is important

Identi- T ™ Stress Assessment

Functional Health, Programme Onboarding

Stress is a normal part of life. Every day, we’re faced with stimuli, called stressors, which can elicit the body’s “fight or flight” response, setting off a cascade of physiological reactions and resulting in emotions ranging from mild to intense. But while occasional stress is natural and even healthy, chronic or acute stress can be harmful.

DASH - ("Disabilities of the Arm Shoulder & Hand")

Orthopaedic

This questionnaire asks about your symptoms as well as your ability to perform certain activities. It doesn’t matter which hand or arm you use to perform the activity; please answer based on your ability regardless of how you perform the task.

Knee Injury and Osteoarthritis Score

Orthopaedic

The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a questionnaire designed to assess short and long-term patient-relevant outcomes following knee injury. The KOOS is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life.

Home workstation Ergonomic Assessment

Orthopaedic

The goal of this self-assessment is to help you set up your workstation for optimal comfort and performance.

SF - 36 Quality of Life Index

Functional Health, Programme Onboarding

The 36 questions reflect 8 domains of health, including physical functioning, physical role, pain, general health, vitality, social function, emotional role, and mental health.

Neck Disability Index

Orthopaedic

This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life.

New patient details form

Onboarding

To ensure your Physio has the maximum time to treat you, please could you complete the Patient Details form by clicking on the link. You can use your phone or PC to complete.

Brief Pain Inventory

Onboarding, Baselines

Tell us a little bit about why you are coming to Physiotherapy. This helps your therapist understand your specific needs and also establishes a baseline that we can measure progress against.

Oshwestry Low Back Disability Index

Orthopaedic

This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by checking ONE box in each section for the statement which best applies to you.

Physical Activity Index

Cardiorespiratory Fitness

Cardio Respiratory Fitness is the single most potent Vital Sign that predicts your health & mortality.

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