Questionnaire for New Patients

The following questions are concerning your time during the COVID-19 lockdown.

    1. During the closure have you been:
    a) not workingb) working from homec) working as normal

    2. If working from home have you been working from a usual desk setup or not?
    a) Usual setupb) Different set-upc) does not apply

    3. Have you been more or less sedentary than normal?
    a) Moreb) Less

    4. If less, what new activities have you been doing?

    5. For how long, and how frequently have you been doing this exercise?

    6. How well do you feel you have dealt with the stress of COVID-19 on a scale of 1-10 with 1 being not dealing well at all, and 10 being I have dealt very well and felt no stress.

    7. Has the quality of your diet improved or declined?
    a) improvedb) declined

    8. How many units of alcohol have you consumed during an average week?

    9. Have you had symptoms of COVID-19?
    a) yesb) no

    10. If answered yes to question 9, have you been tested positive for COVID-19?
    a) yesb) noc) does not apply

    11. Do you have any of the common comorbidities associated with Covid-19?
    a) Hypertensionb) Diabetesc) COPDd) Cardiovascular Disease or Atrial Fibrillatione) Cancer in the last 5 years

    12. Since your last adjustment, do you feel the progress you had made so far has continued to improve, maintained or relapsed to a degree?
    a) improveb) maintainedc) relapsed

    13. Do you have any new symptoms that were not present before the closure?

    14. Have you had any new injuries such as trips, falls, concussions, broken bones etc?

    15. Have you continued to carry out the exercises prescribed by your practitioner to the exact recommendation?
    a) yesb) no

    16. Are there any other health and lifestyle concerns that we can help support you with?