This takes about 4–6 minutes. Your responses help your therapist understand your body before they touch it — so your session starts with intention, not guesswork.
No name is collected. Your responses are linked to a private session code only your therapist can read.
Session code: —
Step 1 of 5 — Where it lives
Map what you're feeling.
Tap your body to mark areas of concern. Use the legend to distinguish your primary complaint, secondary discomfort, and anywhere pain travels or radiates.
Step 2 of 5 — How it feels
Describe what you feel.
Select everything that describes your primary complaint. Then tell us how long it's been part of your life.
SENSATION QUALITY — select all that apply
🫀Aching / dull
⚡Sharp / stabbing
🔥Burning / hot
〰️Throbbing / pulsing
🔗Tight / pulling
🧊Numb / tingling
⏱️Constant
🔄Comes and goes
🚶Worse with movement
HOW LONG HAS THIS BEEN PRESENT?
3 months
drag to adjust
Days1 week1 month6 months1 yearYears
DID ANYTHING COINCIDE WITH WHEN THIS STARTED?
🤕
Injury or accident
😰
Stress or major life event
💼
Job change or new posture demand
😴
Sleep disruption
🏋️
New or increased exercise
❓
No clear reason
Step 3 of 5 — What it costs you
What has this taken from you?
Tap the dots to rate how much each activity is affected — more dots means more impact. This tells your therapist what matters most to restore.
Step 4 of 5 — The full picture
Mind, body, and context.
Pain doesn't live in isolation. These questions help your therapist understand the full environment your body is in — not to judge, just to treat you better.
5
NoneOverwhelming
5
PoorExcellent
HOW DO YOU SPEND MOST OF YOUR DAY?
Desk / seated
Standing
Physical labor
Driving
Varies
ANYTHING ELSE YOUR THERAPIST SHOULD KNOW?
This goes directly to your therapist and is not stored long-term.
Step 5 of 5 — Your session
Set your preferences.
Help your therapist work with you, not just on you.
PRESSURE PREFERENCE
Light — gentle and calming
Medium — moderate depth
Firm — deep work preferred
Varies by area
AREAS TO AVOID COMPLETELYGOAL FOR TODAY'S SESSION
Pain relief
Restore mobility
Stress and relaxation
Maintenance
Injury recovery
✅
You're all set.
Your therapist has everything they need. When you arrive, your session will begin with intention — they've already reviewed your assessment.
Your session code. Your therapist will use this to pull up your assessment.