Pre-Assessment Questionnaire

Pre-Appointment Questionnaire

Patient ID (see appointment confirmation email)

When is your next appointment?

14:30

What would you like help with?

How long has this been going on?

What makes it better?

What makes it worse?

What are your goals? How will you know when you have acheived these? What would be a resonable time frame for you to achieve this?

What else could be preventing you from achieving your goals?

Do you have any other health concerns? eg. other symptoms, ongoing health conditions, history of cancer, accidents, injuries or surgery? Please indicate if there is something that you would prefer to discuss in person. Returning patients can provide an update since their last appointment.

How confident are you that you will achieve your goals?

Confident

Don't know

Doubtful

Thanks, see you soon!