Personal Details
Medical History
Pain Assessment
Body Chart
Questionnaire
Question 1
Personal Details
Question 2
Body Metrics
Question 3
In case a Free T-shirt has to come your way, tell us where to send it
Question 4
What is your current employment status?
Question 5
How would you describe your daily lifestyle?
Question 6
How active are you in terms of exercise or sports?
Question 7
What is your profession?
Question 8
How would you describe your current work-life balance?
Question 9
How often do you take breaks during your regular day?
Question 10
How many hours of sleep do you usually get on a typical night?
Question 11
How often do you get up and move around during your workday?
Question 12
What’s your biggest challenge in staying active?
Question 13
If you had an extra hour in your day, what would you do with it?
Question 14
On a scale of 1-10, how motivated are you to improve your work-life balance and activity levels?
         Mild Pain
Moderate pain     

Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Highly Motivated
Not Motivated
Question 15
What’s one thing you could change today to feel more balanced or active?
Question 7
Which best describes your current activity level?
Question 8
How often do you take breaks throughout your day?
Question 9
How many hours of sleep do you usually get on a typical night?
Question 10
What’s your biggest challenge in staying active?
Question 11
If you had an extra hour in your day, what would you do with it?
Question 12
On a scale of 1-10, how motivated are you to improve your activity levels?
         Mild Pain
Moderate pain     

Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Highly Motivated
Not Motivated
Question 13
What’s one thing you could change today to feel more balanced or active?
Question 1
Have you had any surgeries before?  If YES, please mention the date and nature of the surgeries?*
The surgery may be related to any part of the body within the last year or since the onset of your symptoms.
Question 2
Do you have any allergies or relevant medical history that we should be aware of?
Question 3
What’s your primary goal with our program?
Question 4
What kind of activities or moments do you miss due to this pain?
Question 5
What is your end goal from recovery?
Question 6
Do you have any chronic health conditions? If YES, please specify.*
Like Diabetes, hypertension, Thyroid, PCOD etc
Question 7
How much control do you feel you have over your recovery?*
Question 8
Has the injury impacted your mental/emotional health?*
Question 9
How do you feel about your current injury/recovery state?*
Question 10
How much impact has the injury had on your way of living?
Question 11
How many health providers have you tried before approaching Granimals?
Question 12
Have you undergone any tests for this current injury or concern? If YES, please upload the reports here.
Like., X-ray, MRI, CT scan)
Select a file or drag and drop here
Max file size 10MB.
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Question 1
How INTENSE is your pain right now?
On a scale of 0 to 10, rate how strong or overwhelming the pain feels in the moment
         Mild Pain
Moderate pain     

Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No pain
Intense Pain
Question 2
Describe how SHARP the pain feels.
The sharp pain usually feels like a stabbing or piercing sensation. Rate how sharp or piercing your pain is on a scale of 0 to 10.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No Sharp
Extremely Sharp
Question 3
Describe how HOT the pain feels.
Some pain may feel burning as if heat is radiating from the affected area. Rate how much of a burning or fiery sensation you experience.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Hot
Burning
Question 4
Describe how DULL the pain has felt over the past week.
Dull pain is often persistent and achy, like a low-level constant discomfort. Rate how dull or achy your pain has been.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Dull
Very Dull
Question 5
Describe how COLD the pain feel
Sometimes, pain can feel icy or cold, as though the affected area is freezing. Rate how much your pain feels cold or chilled.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No Pain
Burning
Question 6
Is the area of pain SENSITIVE to touch?
When touched, does the area of pain feel hypersensitive? Rate how sensitive or painful the touch feels in the affected area.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Sensitive
Very Sensitive
Question 7
Does the pain area feel TENDER on touch?
Tenderness can make even gentle touch uncomfortable or painful. Rate how tender the area feels on a scale of 0 to 10.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Tender
Most Tender
Question 8
How ITCHY does your pain feel?
Pain can sometimes have an itchy component, as if you need to scratch the affected area. Rate how itchy your pain feels
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Itchy
Very Itchy
Question 8
How much your pain has felt like it has been SHOOTING over the past week?
Shooting pain can feel like sudden, sharp zaps or jolts. Rate how often and intense this shooting or electric pain feels.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Shooting
Zapping
Question 9
How NUMB has your pain felt over the past week?
Numbness may feel like a lack of sensation or a dull, tingly deadness. Rate how numb your pain has felt.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Numb
Most Numb
Question 10
How has your pain been TINGLING over the past week?
Tingling pain feels like pins and needles or a prickly sensation. Rate how much tingling you've felt.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No Tingling
Most Tingling
Question 11
How CRAMPING your pain has felt over the past week?
Cramping pain often feels like muscle tightening or spasms. Rate how much cramping sensation you’ve felt.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Cramping
Most Cramping
Question 12
How RADIATING your pain felt over the past week?
Radiating pain spreads from one area to another like a wave of discomfort. Rate how much your pain has radiated.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Radiating
Most Radiating
Question 13
How THROBBING was your pain over the past week?
Throbbing pain feels like rhythmic pulsing or pounding. Rate how intense this sensation has been.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Throbbing
Most Throbbing
Question 14
How ACHING has your pain felt over the past week?
Aching pain is often a deep, persistent soreness. Rate how much aching you’ve felt.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Throbbing
Most Throbbing
Question 15
How HEAVY your pain has felt over the past week?
Some pain feels like a weight pressing down or a sense of heaviness in the area. Rate how heavy your pain has felt.
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Heavy
Most Heavy
Question 16
Now that we have squared what kind of pain you have felt over the past week,
it’s time to tell us how UNPLEASANT your pain has been over the past week.
On a scale of 0 to 10, rate how uncomfortable or unbearable your pain has been overall
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
Not Unpleasant
Intolerable
Please indicate the areas of your body where you are experiencing pain by clicking on them
FRONT
BACK
CLICK TO SHOW BACK
CLICK TO SHOW FRONT
FRONT
BACK
CLICK TO SHOW BACK
CLICK TO SHOW FRONT
Question 1
How often do you experience knee pain or discomfort?
Question 2
Do you experience knee pain or discomfort while twisting/pivoting your knee?
Question 3
Do you experience knee pain or discomfort while straightening your knee fully?
Question 4
Do you experience knee pain or discomfort while bending your knee fully?
Question 5
Do you experience knee pain or discomfort while walking on flat surfaces?
Question 6
Do you experience knee pain or discomfort while going up or down stairs?
Question 7
Do you experience knee pain or discomfort at night while in bed?
Question 8
Do you experience knee pain or discomfort when you are sitting or lying?
Question 9
Do you experience knee pain or discomfort when you are standing upright?
Question 10
Do you feel that your knee joint is swelling?
Question 11
Do you feel grinding, hear clicking or any other type of noise when your knee moves?
Question 12
Does your knee catch or hang up when moving?
Question 13
Can you straighten your knee fully?
Question 14
Can you bend your knee fully?
Question 15
 Do you experience knee pain or discomfort while descending stairs?
Question 16
Do you experience knee pain or discomfort while ascending stairs?
Question 17
Do you experience knee pain or discomfort while rising from sitting?
Question 18
Do you experience knee pain or discomfort while standing?
Question 19
Do you experience knee pain or discomfort while bending to the floor/picking up an object?
Question 20
Do you experience knee pain or discomfort while walking on a flat surface?
Question 21
Do you experience knee pain or discomfort while getting in/out of a car?
Question 22
Do you experience knee pain or discomfort while going shopping?
Question 23
Do you experience knee pain or discomfort while putting on socks/stockings?
Question 24
Do you experience knee pain or discomfort while lying in bed (turning over, maintaining knee position)?
Question 25
Do you experience knee pain or discomfort while sitting?
Question 26
Do you experience knee pain or discomfort while getting on/off the toilet?
Question 27
Do you experience knee pain or discomfort while doing any heavy domestic duties (moving heavy boxes, scrubbing floors)?
Question 28
Do you experience knee pain or discomfort while doing any light domestic duties (cooking, dusting)?
Question 29
Do you experience knee pain or discomfort while squatting?
Question 30
Do you experience knee pain or discomfort while running?
Question 31
Do you experience knee pain or discomfort while jumping?
Question 32
Do you experience knee pain or discomfort while twisting/pivoting on your injured knee?
Question 33
Do you experience knee pain or discomfort while kneeling?
Question 34
How often are you aware of your knee problem?
Question 35
Have you modified your lifestyle to avoid potentially damaging activities to your knee?
Question 36
How much are you troubled with a lack of confidence in your knee?
Question 37
In general, how much difficulty do you have with your knee?
Question 1
How would you rate the average pain in your shoulder over the past week?
Question 2
How satisfied are you with your shoulder's current condition?
Question 3
Rate your ability to use your arm in the following positions.
Overhead reaching
Question 4
Rate your ability to use your arm in the following positions.
Reaching behind your back
Question 5
Lifting a heavy object
Rate your ability to use your arm in the following positions.
Question 6
Rate your ability to use your arm in the following positions.
Throwing a ball
Question 7
Rate your ability to use your arm in the following positions.
Washing your back
Question 8
Rate your ability to use your arm in the following positions.
Carrying a heavy object
Question 9
Rate your ability to perform the following everyday activities
Combing your hair
Question 10
Rate your ability to perform the following everyday activities
Dressing yourself
Question 11
Rate your ability to perform the following everyday activities
Eating with utensils
Question 12
Rate your ability to perform the following everyday activities
Brushing your teeth
Question 13
Rate your ability to perform the following everyday activities
Putting on a coat or jacket
Question 14
Rate your ability to perform the following everyday activities
Using a telephone or computer
Question 1
 During the last week, how often have you experienced pain in your foot/ankle?
Question 2
During the last week, how severe was your pain when twisting/pivoting on your foot/ankle?
Question 3
During the last week, how severe was your pain when fully straightening your foot/ankle?
Question 4
During the last week, how severe was your pain when walking on a flat surface?
Question 5
During the last week, how severe was your pain when going up or down stairs?
Question 6
During the last week, how severe was your pain at night while in bed?
Question 7
During the last week, how severe was your pain while sitting or lying down?
Question 8
During the last week, how severe was your pain when standing upright?
Question 9
 Have you had swelling in your foot/ankle in the past week?
Question 10
Have you felt grinding, crunching, or any other kind of noise or sensation from your foot/ankle in the past week?
Question 11
During the last week, have you felt your foot/ankle catch or slip out of place?
Question 12
How severe has the stiffness in your foot/ankle been in the morning after waking up?
Question 13
How severe has the stiffness in your foot/ankle been after sitting, lying, or resting later in the day?
Question 14
How difficult was it to descend stairs in the past week?
Question 15
How difficult was it to ascend stairs in the past week?
Question 16
How difficult was it to stand in the past week?
Question 17
How difficult was it to rise from sitting in the past week?
Question 18
How difficult was it to bend to the floor or pick up an object in the past week?
Question 19
How difficult was it to walk on flat ground in the past week?
Question 20
How difficult was it to get in and out of a car in the past week?
Question 21
How difficult was it to go shopping in the past week?
Question 22
How difficult was it to put on socks/stockings in the past week?
Question 23
How difficult was it to rise from bed in the past week?
Question 24
How difficult was it to take off socks/stockings in the past week?
Question 25
How difficult was it to lie in bed in the past week?
Question 26
How difficult was it to sit in the past week?
Question 27
How difficult was it to get on/off the toilet in the past week?
Question 28
How difficult was it to do heavy domestic duties (moving furniture, washing windows, etc.) in the past week?
Question 29
How difficult was it to do light domestic duties (cooking, dusting, etc.) in the past week?
Question 30
How difficult was it to squat in the past week?
Question 31
How difficult was it to run in the past week?
Question 32
How difficult was it to jump in the past week?
Question 33
How difficult was it to twist/pivot on your injured foot/ankle in the past week?
Question 34
How difficult was it to perform your usual sport/recreational activities at your normal level in the past week?
Question 35
How often are you aware of your foot/ankle problems in your daily life?
Question 36
Have you had to modify your lifestyle to avoid activities that may cause foot/ankle pain in the past week?
Question 37
How much are you troubled by the lack of confidence in your foot/ankle?
Question 38
In general, how much difficulty do you have with your foot/ankle?
Question 1
How much difficulty do you have with the following activities because of your hip?
Standing for 15 minutes
Question 2
How much difficulty do you have with the following activities because of your hip?
Standing for 1 hour
Question 3
How much difficulty do you have with the following activities because of your hip?
Walking up to 15 minutes
Question 4
How much difficulty do you have with the following activities because of your hip?
Walking up to 1 hour
Question 5
How much difficulty do you have with the following activities because of your hip?
Going up a flight of stairs
Question 6
How much difficulty do you have with the following activities because of your hip?
Going down a flight of stairs
Question 7
How much difficulty do you have with the following activities because of your hip?
Sitting for 15 minutes
Question 8
How much difficulty do you have with the following activities because of your hip?
Sitting for 1 hour
Question 9
How much difficulty do you have with the following activities because of your hip?
Squatting
Question 10
How much difficulty do you have with the following activities because of your hip?
Lifting an object from the floor
Question 11
How much difficulty do you have with the following activities because of your hip?
Getting into/out of a car
Question 12
How much difficulty do you have with the following activities because of your hip?
Walking on uneven surfaces
Question 13
How much difficulty do you have with the following activities because of your hip?
Light to moderate work (standing, walking)
Question 14
How much difficulty do you have with the following activities because of your hip?
Heavy work (lifting or carrying heavy objects)
Question 15
How much difficulty do you have with the following activities because of your hip?
Getting in and out of the bath
Question 16
How much difficulty do you have with the following activities because of your hip?
Putting on socks/shoes
Question 17
How much difficulty do you have with the following activities because of your hip?
Running straight ahead
Question 18
How much difficulty do you have with the following activities because of your hip?
Running and decelerating
Question 19
How much difficulty do you have with the following activities because of your hip?
Running and twisting/cutting
Question 20
How much difficulty do you have with the following activities because of your hip?
Jumping
Question 21
How much difficulty do you have with the following activities because of your hip?
Landing from a jump
Question 22
How much difficulty do you have with the following activities because of your hip?
Putting on socks/shoes
Question 23
How much difficulty do you have with the following activities because of your hip?
Swinging objects (golf club, tennis racquet, etc.)
Question 24
How much difficulty do you have with the following activities because of your hip?
Kicking
Question 1
Which elbow is causing the discomfort?
Question 2
How long have you been suffering from elbow pain?
Question 3
 What is your hand dominance?
Question 4
Please describe how and where your symptoms occurred/how you injured your elbow.
Question 5
Select all the options that describe your elbow pain.
Question 6
What is associated with your elbow pain? (check all that apply)
Question 7
Describe the timing of your pain. (check all that apply)
Question 8
What aggravates or alleviates your elbow pain? (check all that apply)
Question 8
How severe is the pain on a scale of 0-10?
Initially
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No pain
Worst pain
Currently
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No pain
Worst pain
On a bad day
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No pain
Worst pain
On an average day
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No pain
Worst pain
On a good day
Mild Pain
Moderate pain
Severe pain
Most Intense
pain imaginable
1
2
3
4
5
6
7
8
9
10
No pain
Worst pain
Question 10
 How long have you had your elbow pain?
Question 11
What are you currently using to treat the elbow pain? (select all that apply)
Question 12
 Have you had any procedures or surgeries to treat the elbow pain? If yes, what type?
Question 13
What diagnostic imaging studies have you had for this problem? (Check all that apply)
Question 14
How has this problem limited you? (check all that apply)
Question 15
Who have you seen for this problem? (check all that apply)
Question 1
Describe the PAIN INTENSITY
Question 2
Describe any NUMBNESS AND TINGLING sensation felt:
Question 3
Describe the difficulty faced for  PERSONAL CARE (WASHING, DRESSING, ETC.)
Question 4
Describe the STRENGTH of the hand/wrist
Question 5
Describe your WRITING/TYPING TOLERANCE
Question 6
Describe how much WORK you can do
Question 7
Describe how much you can DRIVE
Question 8
Describe your SLEEPING patterns
Question 9
Describe how much HOUSE AND YARD WORK you do
Question 10
Describe your RECREATION AND SPORTS activity level
Question 1
How difficult is it to perform the following activities because of your lower back?
Getting out of bed
Question 2
How difficult is it to perform the following activities because of your lower back?
Sleeping through the night
Question 3
How difficult is it to perform the following activities because of your lower back?
Turning over in bed
Question 4
How difficult is it to perform the following activities because of your lower back?
Get in a car
Question 5
Standing up for 20-30 minutes:
How difficult is it to perform the following activities because of your lower back?
Question 6
How difficult is it to perform the following activities because of your lower back?
Sitting in a chair for several hours:
Question 7
How difficult is it to perform the following activities because of your lower back?
Climbing one flight of stairs:
Question 8
How difficult is it to perform the following activities because of your lower back?
Walking a few blocks (300-400 m):
Question 9
How difficult is it to perform the following activities because of your lower back?
Walking several kilometres:
Question 10
How difficult is it to perform the following activities because of your lower back?
Reaching up to high shelves:
Question 11
How difficult is it to perform the following activities because of your lower back?
Throwing a ball:
Question 12
How difficult is it to perform the following activities because of your lower back?
Running one block (about 100m)
Question 13
How difficult is it to perform the following activities because of your lower back?
Taking food out of the refrigerator
Question 14
Making your bed
How difficult is it to perform the following activities because of your lower back?
Question 15
How difficult is it to perform the following activities because of your lower back?
Putting on socks
Question 16
How difficult is it to perform the following activities because of your lower back?
Bending over to clean
Question 17
How difficult is it to perform the following activities because of your lower back?
Pulling or pushing heavy doors
Question 18
How difficult is it to perform the following activities because of your lower back?
Carrying two bags of groceries
Question 19
How difficult is it to perform the following activities because of your lower back?
Lifting and carrying a heavy suitcase
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