Pre-Consult Elbow Pain Questionnaire

First Name *

Last Name *

Email Address *

Phone Number *

How long have you had elbow pain? *

0 - 30 days

DaysMonthsYears5+

Choose one option.

Where does it hurt? * Tap the sore tendon(s).

Palms-up view of both forearms for choosing elbow pain location

Tap at least one elbow zone.

Rate your worst elbow pain during activity. * 0 = none, 10 = stop what I'm doing.

No painWorst

Choose one pain rating.

Who have you consulted with about your tennis / golfer's elbow? * Check all that apply.

General practitioner Orthopedic / sports medicine doctor Nurse or physicians assistant Physical therapist Chiropractor Acupuncturist Personal trainer Tennis / golf pro or coach Non-medical friend / acquaintance who is familiar with tennis elbow None of the above

Select at least one option.

What activities cause your elbow pain? * Check all that apply.

Racquet sports (tennis, pickleball, racquetball, squash) Golf Fitness (cardio, weight lifting, yoga, Pilates) Combat Sports (boxing, MMA, jiu jitsu) DIY (hammer, plumbing, screwdriver, painting) Carrying heavy objects Yardwork (shoveling, raking, gardening) Cooking (chopping, prepping) Outdoor activities (kayaking, biking, canoeing, fishing) Throwing balls (baseball, basketball, football...) Motorcycle, ATV, snowmobile Work - General office work (typing, mouse usage) Work - Non-office work (labor, assembly, server, dental hygienist...) Musical instrument Not sure

Select at least one option.

What treatments have you tried? * Check all that apply.

Stop doing activity(s) that caused tennis elbow pain Over the counter medications (ibuprofen, acetaminophen, aspirin...) Prescription medications (anti-inflammatory, pain medications...) Ice / Heat Self massage Rollers / massage device Percussion device (Theragun, HyperVolt) Redlight therapy Stretching / Strength Exercises Elbow sleeve Forearm band / elbow brace Ultrasound / shockwave therapy TENs Physical therapy Chiropractor Acupuncture Cortisone Platelet rich plasma (PRP) Peptides Stem cell Surgery (same or different tendon) None of the above

Select at least one option.

How much have you paid to treat / fix your tennis / golfer's elbow? (Add up all doctors visits, physical therapy, treatments, devices, braces, sleeves, pills, ointments... Do not include your time) *

$0 - $100 $101 - $250 $251 - $500 $501 - $1,000 $1,001+

Choose one option.

What is your age? *

Under 20 20-29 30-39 40-49 50-59 60-69 70+

Choose one option.

What is your sex? *

Male Female Prefer not to answer

Choose one option.

What is your profession? *

Professional - office Professional - non-office Consultant Medical / Health (doctor, hygienist, PT) Sports professional (trainer, coach, player) Light labor (server, hospitality staff, housekeeping, hair stylist...) Manufacturing / mechanic (assembly line, warehouse, shipping/receiving...) Construction (painter, plumber, electrician, carpenter...) Police, Fire, Rescue, Military… Musician Retired Student Non-employed Other

Choose one option.

How did you 1st learn about the Fiix Elbow? *

Google ChatGPT or other AI Facebook Instagram YouTube TV Commercial Online review Referred by a friend Referred by a coach or trainer Referred by a doctor Referred by a therapist

Choose one option.

Any additional insights about your elbow pain we should know before the call?

What is the #1 question you need answered to decide if Fiix Elbow is right for you?

Please send me helpful emails about treating and preventing elbow pain.

Yes, send me helpful elbow recovery and prevention tips.

Accept Privacy Policy and Medical Advice Disclaimer *

Yes No

Please agree to the disclaimer to continue.

Something went wrong sending your answers. Please try again.

✓

We've received your survey!

One more step: please schedule your virtual consult with your Elbow Coach below.

Loading available times…

✓

Your consult is booked!

A calendar invite is on its way to . Need a different time?

Loading the scheduling calendar…

Calendar not loading? Open the scheduling page in a new tab.