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assessment form page
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2026-01-06T15:48:18+02:00
Current step:
1
Step 1
2
Step 2 - Complaint/Pain
3
Ste 3 - Medical History
4
Step 4 - Occupation and Condition
5
Step 5 - Fitness Level
6
Step 6 - Recovery Therapy
MAI Therapy Assessment Form
January 6, 2026
Step 1 - CONTACT INFORMATION
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Step 2 - CURRENT COMPLAINT/PAIN
Please choose any areas which you are presently experiencing discomfort and/or pain (use figure below for the reference)
Right shoulder
Right hip
Lower back
Right knee
Left shoulder
Left knee
Left hip
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Step 3 - MEDICAL HISTORY
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Step 4 - CURRENT OCCUPATION AND CONDITION
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Step 5 - FITNESS & WELLBEING
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Step 6 - RECOVERY THERAPY
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