Should you see someone about your back?
Do you have back pain?
*
Yes
No
Are you experiencing any of the following symptoms?
*
Constant or intense pain, especially when you are lying down or at night
Pain radiating down one or both of your legs
Weakness, tingling or numbness in one or both of your legs
Unintentional weight loss
Redness or swelling in the region of your pain
No Symptoms
Date of birth
*
-
Day
-
Month
Year
Gender assigned at birth
*
Male
Female
Back
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About you - we use this information to send you reminders and recommendations
First Name
*
Last Name
*
Email
*
example@example.com
Mobile Number
We will only ever SMS you reminders.
Postcode
*
recommendationWP
Submit
Score
If greater than 0, they should see someone.
Should be Empty: