First Name
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Last Name
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Email
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Phone
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What do you know about Shockwave Therapy?
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I know what it is and how it works
I have heard about it's benefits but couldn't explain them
I have no idea what it is, how it works or what it's used for
How long have you been in pain?
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I have no pain
Less than 4 weeks
Between 4-12 weeks
More than 12 weeks
Do you have a clinical diagnosis for your pain?
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Yes (confirmed by a medical professional)
No
Do you have imaging that confirms the diagnosis?
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Yes (ultrasound or MRI)
Other (CT or Xray)
No
Where is your pain located?
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Achilles Tendon (back of the ankle)
Plantar fascia (heel or base of foot)
Patella/Quads Tendon (just above or below the kneecap)
Hamstring Tendon (on you sitting bone)
Gluteal Tendon (outer hip area)
Elbow (tennis or golfers elbow)
Shoulder
Other Area
How would you best describe your pain?
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Stiff and achy, especially in the mornings
Sharp during or after activity
Constant dull ache
Comes and goes unpredictably
Burning or tingling sensation
What treatments have you tried so far?
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Exercise and rehabilitation
Manual therapy or dry needling/acupuncture
Load-management and activity modification
Painkillers or anti-inflammatories
Steroid or other injections
Rest
Tick all that apply
How is the pain affecting your daily life?
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Barely noticeable
Manageable but limiting the things I do
Significantly limiting what I can do
I've had to stop all activities and hobbies
What best describes your outlook on the use of shockwave therapy for your injury?
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I want to use it alongside exercise as a comprehensive treatment plan
I prefer to use it alongside passive treatments such as massage
I am willing to try anything to get better as long as its little effort
I don't know what it is or how it works but I am desperate for some pain relief
Do you have any of the following:
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Active cancer
Blood clotting disorders or vascular conditions
Pacemaker or implanted device
Local infection or open wounds near treatment site
Recent steroid injection near the treatment site
Currently pregnant
Under 18 years of age
None of the above
Tick all that apply