Complete Chiropractic – Shoulder SPADI Shoulder SPADIThis shoulder SPADI form should be used if you have been directed to do so by your doctor.Part 1 About youYour Prefix *Mr.Mrs.Ms.Mx.MissDr.Prof.Your First Name *Your Last Name *Email Address *Section 2 Your shoulder pain This questionnaire is designed to enable us to understand how much your shoulder pain has affected your ability to manage your everyday activities. Please answer each section by selecting the one choice that most applies to you. We realise that you may feel that more than one statement may relate to you, but please choose just the one which fits best.How does your neck pain impact you? How severe is your pain...at its worst? *012345678910How severe is your pain...When lying on the involved side? *012345678910How severe is your pain...Reaching for something on a high shelf? *012345678910How severe is your pain...Touching the back of your neck? *012345678910How severe is your pain...Pushing with the involved arm? *012345678910How much difficulty do you have...Washing your hair? *012345678910How much difficulty do you have...Washing your back? *012345678910How much difficulty do you have...Putting on an undershirt or pullover sweater? *012345678910How much difficulty do you have...Putting on a shirt that buttons down the front? *012345678910How much difficulty do you have...Putting on your trousers? *012345678910How much difficulty do you have...Placing an object on a high shelf? *012345678910How much difficulty do you have...Carrying a heavy object of 10 pounds? *012345678910How much difficulty do you have...Removing something from your back pocket? *012345678910Thank you for completing the shoulder SPADI form. Please check the box below to indicate you have read our privacy policy and then press "Submit".GDPR *Yes, I agree with privacy policy, terms and conditionSubmit formPlease do not fill in this field.
