Yellow letters "CI" on a black background

Consultation & Assessment Form

The assessment helps our practitioner to address the root cause of your musculoskeletal pain and/or discomfort. The assessment includes:

Discussing where you are, and where you would like to be (aka goals and desires - this will serve as the consultation)
A physical assessment
A brief overview of treatment plan and next steps

All assessments are conducted at Iron Web Fitness in Marshfield, MO

DISCLAIMER

We ARE NOT a substitute for physical therapy or surgery.

While we would love to help as many people as possible on their pain free journey, we understand that we may not be the best option for some. After the assessment, it may be apparent that you may need help outside of what we can provide. In this case, we will always work with you to refer you to the best possible option for your needs!

Our lead Practitioner is an Active Life Professional candidate. You can learn more about our lead Practitioner by clicking HERE! Learn more about Active Life, HERE!

Name

First Name

Last Name

Date of Birth

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you had surgery within the past 2-5 years?

Have you been through any form of Physical Therapy? If so, what was your end result?

Please describe your pain and/or discomfort in as much detail as possible including location, length of time, and level of pain (1-10, 10 being extreme),

Preferred time of day to complete Assessment