Athlete Discomfort Assessment
Please complete this assessment to help us understand and address any discomfort or pain you are experiencing during training or competition.
Athlete Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Email
*
example@example.com
Which sport or activity are you currently participating in?
*
Please Select
Running
Swimming
Cycling
Soccer
Basketball
Tennis
Gymnastics
Other
Where are you experiencing discomfort or pain? (Select all that apply)
*
Neck
Shoulder
Back
Arm/Elbow
Wrist/Hand
Hip
Knee
Ankle/Foot
Other
How would you rate your current discomfort or pain level?
*
No pain
0
1
2
3
4
5
6
7
8
9
Worst possible pain
10
0 is No pain, 10 is Worst possible pain
Please indicate the type of discomfort you are experiencing.
*
Sharp pain
Dull ache
Stiffness
Numbness/tingling
Cramps
Other
When did you first notice the discomfort?
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate the impact of discomfort on the following activities:
*
Rows
No impact
Mild impact
Moderate impact
Severe impact
Training performance
1
2
3
4
Daily activities
5
6
7
8
Sleep
9
10
11
12
Mood/motivation
13
14
15
16
Have you taken any actions to address the discomfort? (Select all that apply)
Rested/Reduced activity
Applied ice/heat
Used medication
Consulted a medical professional
Changed training routine
Other
Is there anything else you would like to share about your discomfort or its possible causes?
Submit Assessment
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