Injury Self Test
    GENTLE HANDS-ON HEALTH CARE
          FOR INDIVIDUALS AND FAMILIES
(540) 373-1633

1000 Oakwood Street, Fredericksburg, VA 22401

Home SPECIAL Dr. Schulz Injury Self Test DTS Questions/Answers Contents Location and Hours Schooling

 

* Painful Joints

* Stiffness in the neck

* Pain Between the Shoulder Blades

* Stiffness or Pain in the Lower Back

* Numbness in the Arms or Hands

* Numbness or Pain in the Legs

* Headaches or Dizziness

Determine if you need further evaluation:

Choose the Description that best explains the pain you are experiencing during each of the following activities. If you experience no pain, please leave that question blank.

History

I have never been in an auto accident.

I have been in an auto accident in the past year.

I have been in an auto accident in the past 3 years.

Pain Intensity

I can tolerate the pain I have without using painkillers.

The pain is bad, but I manage without taking painkillers.

Painkillers give me moderate relief from pain.

Lifting

I can lift heavy weights, but it causes extra pain.

Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned.

I can only lift very light weights.

I cannot lift or carry anything.

Sitting

Pain prevents me from sitting for more than one hour.

Pain prevents me from sitting for more than 30 minutes.

Pain prevents me from sitting at all.

Walking

Pain prevents me from walking more than one mile.

Pain prevents me from walking more than ½ mile.

I can only walk using a cane or crutches.

Social Life

My social life is normal, but increases the degree of pain.

Pain has limited my social life and I do not have as much energy to do the things I enjoy. I do not go out as often.

Pain has restricted my social life to my home.

 

IF you have chosen TWO OR MORE of the descriptions in other than the top box of each category, pain resulting from injury is definitely affecting the quality of your life. IF YOUR LIFE IS BEING AFFECTED DUE TO AN ACCIDENT, YOU MAY BE ENTITLED TO TREATMENT OF YOUR INJURIES WITHOUT ANY OUT-OF-POCKET EXPENSE. Do not sit back an accept this as the way it has to be – fight back! If you don’t stand up for your health and injuries, who will? Your first step is this: FIND OUT IF YOU ARE INJURED! Call Schulz Chiropractic right now; tell them you have completed the self test and would like a further evaluation.

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