Injury Questionnaire

Name:

Date of Birth:

Sports Played

Contact Number:

Email:

Section 1: Health History

Have you experienced any previous Injuries?

Have you had any surgeries or medical procedures related to sports?

Do you have any chronic conditions (e.g., asthma, diabetes)?

Are you currently taking any medications?

Section 2: Injury Details

Have you experienced any of the following injuries in the past year? (Check all that apply)

For each injury listed above, please provide:

Section 3: Pain Assessment

On a scale of 1-10, how would you rate your overall pain level related to sports activities?

Please describe any specific areas of pain or discomfort during activities:

Section 4: Activity Limitations

Do you currently have any limitations in your athletic performance due to injuries?

Are there any specific movements or exercises that exacerbate your pain?

Section 5: Goals and Expectations

What are your primary goals in joining our sports performance gym?

Are there any specific programs or training methods you are interested in?

Section 6: Consent

Date

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