Welcome to our unique and easy to use On-Line Consultation Service

Please complete the questions below as the first step to our on-line consultation service
* denotes a required field

	State in as much detail as possible where you are feeling pain
Name*
Age*	Please Select Less than 16 Years 17 to 25 Years 26 to 40 Years 41 to 60 Years Older than 60 Years
Sex*	Please Select Male Female
What is your occupation
What are your main hobbies
E-mail*
Main pain started...	Please Select Gradually Suddenly
How long have you had the problem...	Please Select Less than 24 hours More than 24 hours 3 Days 1 Week 1-4 Weeks More than 4 Weeks
How would you describe the pain...	Please Select Ache Sharp Nagging
Do you have the pain there all the time...	Please Select Yes No
Do you have pain at night...	Please Select Yes No
Have you felt the same pain before...	Please Select Yes No
Have you had treatment for the problem before...	Please Select Yes No
Are you in pain first thing in the morning...	Please Select Yes No
Are you stiff in the morning...	Please Select Yes No
Does your pain get better through the day...	Please Select Yes No
Is the pain worse before you go to bed or first thing in the morning...	Please Select Before bed First thing
Does it wake you at night...	Please Select Yes No
Does it hurt turning over in bed...	Please Select Yes No
Does it hurt standing up from sitting down or sitting down from standing up...	Please Select Yes No
Does it hurt going up or down stairs...	Please Select Yes No
Has your pain affected your toilet habits...	Please Select Yes No
Do you go to the toilet more often...	Please Select Yes No
Do you need to rush to the toilet...	Please Select Yes No
Do you experience any numbness or a feeling of pins and needles in between your legs...	Please Select Yes No
Is there any pain when you cough, sneeze or laugh...	Please Select Yes No
When the pain is bad does it cause you to limp when you walk...	Please Select Yes No
Have you lost any unexplained weight recently...	Please Select Yes No
Since the onset of your problem have you experienced headeaches...	Please Select Yes No Not Applicable
If you have been experiencing headaches, is your headache mainly...	Please Select at the back of the head above eyes and over forehead over one or both temples from back of head to eyes over top of head from back to front Not applicable
Do you experience any tingling, burning or numb sensations...	Please Select Yes No Not Applicable
If you do experince any tingling, burning or numbness do you mainly feel it...	Please Select in one arm and into hands & fingers in both arms, hands & fingers in one leg and into the foot in both legs and feet Not applicable
Do you feel...	Please Select Dizzy Nausea Unsteady on your feet Not applicable
Since the onset of your problem have you experienced any blurred vision	Please Select Yes No Not Applicable