Remote consultation

Make your physiotherapy consultation online by filling out the form below and a physiotherapist from the team will contact you as soon as possible to help you.

Personal and contact details

Do you do physical activity or sport?

Reason for your enquiry

Please respond to the following Do you have any of these symptoms?

	General malaise
	Fever
	Weight loss of more than 5kg in the last 2 weeks
	I've had some kind of cancer
	Prolonged treatment with corticoids
	Recent trauma (falls, accidents, blows, etc)
	The pain is much worse at night
	Altered sensation in the extremities (tingling, numbness...)
	My doctor has recommended bed rest
	I have feelings of dizziness, loss of balance or impaired vision
	None of the above

Indicates if you have any diagnosed systemic disease (rheumatic diseases, autoimmune, cardiovascular, diabetes, hypothyroidism, osteoporosis, cancer, etc)

Are you taking any medication?

How long have you been in this pain?

	Less than a week
	I've been in pain for 2 to 6 weeks
	I've been over 6 weeks

Concerning your pain behavior

	It increases when I make movements with the part of the body that hurts or when I walk.
	It decreases when I make movements with the part of the body that hurts or when I walk.
	It hurts just as much when moving as when resting on the bed or sofa.
	It hurts more when I sit for a long time.
	It hurts more when I stand for a long time.
	It hurts more in the morning and gets better as the day goes on.
	In the morning it hardly hurts, but as the day goes on the pain gets worse.
	It's at night that it hurts the most.
	As the days go by, it hurts less.
	As the days go by, it hurts more.
	It hurts the same now as when the pain started.

What activities and/or tasks can't you do because of the pain?

How much do you worry about your pain?

Has that ever happened to you before?

Have you ever been to the physio?