Musculoskeletal Injury Risk Assessment

SECTION A - DEMOGRAPHICS

2. Sex *

Male

Female

Prefer not to say

SECTION B - CURRENT PAIN AND SYMPTOMS

3. Do you currently experience pain or discomfort? *

No pain

Occasional pain

Frequent pain

Daily or constant pain

SECTION C – FUNCTION & CAPACITY

5. How would you rate your current mobility? *

Excellent

Good

Fair

Poor

SECTION D – ACTIVITY & LIFESTYLE

7. How physically active are you? *

Highly active (4–5+ days/week)

Moderately active (2–3 days/week)

Lightly active (1 day/week)

Sedentary

8. Primary daily activity *

Desk-based work

Manual / physical work

Retired

Sport / training focused

SECTION E – INJURY HISTORY

9. Have you had an injury in the past 12 months? *

No

Yes - minor

Yes - required treatment

Yes - ongoing or unresolved

10. Have you had surgery related to bones, joints, or muscles? *

No

Yes - fully recovered

Yes - ongoing issues

SECTION F – FALLS / SAFETY

11. Have you fallen in the past 12 months? *

No

Yes - no injury

Yes - injury occured

SECTION G – YOUR DETAILS

Full Name *

Email *

Mobile Number *

By submitting I consent to receiving my results and follow-up health information from Doveston Health.