What is Osteopathy?
About Matt Stanford
What Do Osteopaths Treat?
Sports Injuries
Therapeutic Ultrasound
Stretching Advice
Exercise Advice
What Happens in a Treatment?
Explanation Of Your Problems
Yoga,Pilates and Core Stability
Rehabilitation
Can my GP Refer Me?
How Much Does It Cost?
Before you visit
Contact Details / Directions
Links - G5 massage
- Matt's Articles

PATIENT QUESTIONNAIRE

Please tick if you regularly suffer from any of the following:

Recent weight gain Chest pain
Recent weight loss Chest, arm or jaw pain
Fatigue on exertion / exercise
Weakness Heart palpitations
Fever Swollen ankles / feet
Chills Shortness of breath
Nightsweats Coughing
Excessive thirst Cold hands / feet
Excessive sweating High blood pressure
       
Nausea   For women only
Vomiting Irregular periods
Heartburn Early menopause
Constipation Bleeding after menopause
Diarrhoea Other gynaecological problems
Blood in stools    
Black stools   Please list any major accidents
Abdominal pain  
Stomach pain relieved  
By food or drink  
Difficulty swallowing foods  
Or liquids>  
Difficulty starting or stopping urination   Please list any major operations
Change in frequency of urination  
Pain/burning on urination  
Blood in urine  
     
Blackouts  
Headaches   Please list any major illnesses
Migraines  
Dizziness  
Loss of balance  
Fainting  
Change in vision  
Ringing in ears   Has any of your family suffered from:
Memory loss Diabetes
Areas of numbness Cancer
Areas of pins and needles Heart conditions
Slurred speech Other - Please specify below.
Fits  
Name:
Phone Number:
Email Address:
   
To make an appointment call 01892 543033 / 07990 854429
There is free parking onsite. Treatment is possible through light clothing