Welcome!
Being free of pain and limitation is part of your biological design, when your body is in a balanced state. But when your body is out of balance, these things continue to show up as constant physical and emotional reminders. This quiz can help us understand where you're currently at and if Symmetry Of Motion can be a solution for you. It should only take a few minutes.
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Do you have any diagnosed injuries or medical conditions related to what you are looking for help with?
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Yes
No
If Yes, what is it?
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Do you currently suffer from pain anywhere in your body? (constant or not)
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Yes
No
Where?
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Have you seen a chiropractor, massage therapist, physical therapist, or other practitioner for the above conditions or with pain?
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Yes
No
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Do you still suffer from the same problem(s) or pain despite all other solutions you have tried?
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Yes
No
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Which of the following has this pain and/or problem(s) interfered with? (choose all that apply)
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Fitness or other physical activities
Work / Career
Travel / Trips
Social interactions or events
Other
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How long has this pain or problem(s) affected you?
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0-1 Month
1-6 Months
6-12 Months
1 - 5 Years
More than 5 Years
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Do you ever experience pain or discomfort in the following? (check all that apply)
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Laying on your stomach
Sitting for short/long periods of time
Walking after a period of time
Jogging or Running after a period of time
During or after a workout
While sleeping at night
Morning activities like bending over to brush your teeth
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Do you have parts of your body that feel "tighter" or "weaker" than other parts of your body?
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Yes
No
If so, what are they?
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Do either of your feet point in or out when you stand relaxed?
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Out
In
Both are straight
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Try this: Stand up with your shoes off (if you can). Do you feel like your weight is heavier towards one leg/foot than the other leg/foot?
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Left Leg
Right Leg
Feels Centered
I'm not sure
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Is the pressure of either foot against the ground not centered? Example: More towards the heel, toes, inside or outside edge.
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Yes - one or both feet are not centered
No - both are centered
I'm not sure
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Try this: Stand with one leg in the air (as below). Do you feel a difference in how your body balances or shifts around on one leg compared to standing on the other leg?
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Yes, one side balances different than the other
No, both sides feel like they do the same thing
I'm not sure
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Try this: Lay in this position (below). Think about your hips, back, and shoulders against the floor. Does any part of your body feel lighter or heavier (or just different) against the floor?
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Yes, I feel parts that are lighter or heavier
No, everything feels completely flat and even
I'm not sure
I'm unable to try this right now (no prob..doesn't ruin the assessment)
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Is there anything else you want to mention that we haven't brought up so far?
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What is the reason you are submitting this form?
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0/75
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Name
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First Name
Last Name
Email
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example@example.com
Phone Number
Please enter a valid phone number.
Submit
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