What's Your Score?

Use our online form to learn more about your health risks and to monitor your injury treatment and progression. Fill out the information below and you will receive an email containing the link to your personal account with the results of this questionnaire.

MSDR®Wellness Assessment
First Name:
Last Name:
Email:
Create a Password:
Confirm Password:
Gender:
Age:
Height:
(feet) (inches)
Weight:
lbs
Have you have multiple injuries to the same region? Or have you been in pain for more than 1 year?
If so, Which region is affected?
Do you have a family history of arthritis?
Have you had treatment for this condition?
Are you a Smoker?
Describe your level of activity:
Do, or did you ever perform heavy repetitious physical activity with the part of your body that is bothering you?
During the next portion of this questionnaire please refer to the images while answering the question.

Is your ear more forward rather than even with your shoulder?

 Yes
Is your ear more forward rather than even with your shoulder? Yes
Is your ear more forward rather than even with your shoulder? No
 
Are your shoulders rolled forward?
 Yes
Are your shoulders rolled forward? Yes
Are your shoulders rolled forward? No
 
Are your shoulders uneven?
Hold a ruler as shown in the image. Do this with each arm. If the results are different, your answer is yes.
 Yes
Are your shoulders uneven? Yes
Are your shoulders uneven? No
 
Sitting down in a chair, if you extend each leg as shown in the image, do you feel tightness in the back of your leg?

Sitting down in a chair, if you extend each leg as shown in the image, do you feel tightness in the back of your leg?

 Yes

 
Laying face up, pull one knee to your chest, do you feel pain in your knees and/or hips?
 Laying face up, pull one knee to your chest, do you feel pain in your knees and/or hips?

 Yes


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