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Persistent Pain Management
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Pre-employment and Musculoskeletal Screening
Workplace assessment / Home visits / Telehealth
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Pelvic Pain Conditions
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Townsville Physio Blog
Telehealth Injury Screening Form
Date of Birth
Tell us a little about your injury or condition:
When did it start? Was there a moment in time when your pain started or was the onset more gradual?
Have you experienced this before?
Have you experienced any recent significant trauma e.g. falls / car accidents?
Rate your pain on a scale of 0-10 (0 = no pain, 10 = worst pain imaginable):
Please describe where you a feeling most of your symptoms:
What aggravates your symptoms?
Is there anything that provides relief?
What is your Occupation?
Do you participate in any sports / hobbies / other regular activities?
Previous Surgical history:
Any other information you think may be helpful:
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