Could your chronic low back pain be treatable?
Our interactive questionnaire will help guide you toward the best outcome. We assess every single form personally, and contact you with the results. Only the red asterisk questions are required - you may give as much or little detail as you like. Scroll down to get started!
How old are you?
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This is essential - if under 18 or over 50 it can be medically relevant.
Which diagnosis best describes your back pain? (select as many as relevant)
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Generalised Low Back Pain
Back Pain referring into the buttock/s
Back Pain referring into the leg/s
Disc Issues in the Back (degeneration, bulges etc)
Nerve Impingement in the Back
Tight muscles or joints in the back
Back Pain with Pins and Needles
Unstable Back
Back Pain caused by a weak core
Post- Back Surgery
Other (specify below)
I'm not sure
If "Other", please specify here
How long have you had the back pain for?
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Less than 3 months
3 months to a year
1-5 years
5-10 years
10 years+
What are you currently doing to manage your Back Pain?
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Have you ever had your back assessed or treated before?
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Yes
No
If yes - by who? What was the outcome?
What movements or positions hurt your back the most?
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What would you like the next step to be, once this form is reviewed by one of our expert team?
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Speak to one of our team on the phone
Book the next available appointment
Get more information
Choose a time to speak to a team member
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Type a question
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
-
Area Code
Phone Number
Click here to Submit and Get Some Answers!
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