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What area is affected?

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What area is affected - specify

What is the nature of the problem?

Sudden injury (e.g., fall, sports injury)

Ongoing pain (chronic condition)

Swelling or inflammation

Restricted movement

Post-surgical complication

Other (please specify)

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What is the nature of the problem - specify

When did the symptoms or injury start?

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Are you currently experiencing any of the following?

Severe pain not relieved by medication

Inability to walk or use the arm

Suspected fracture or dislocation

Post-surgical complication or signs of infection (e.g., fever, redness, discharge)

None of the above

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Have you had any previous procedures or treatments related to this issue?

Yes

No

If yes, please describe the treatment, approximate dates, and outcomes.