Carpal Tunnel Treatment - Carpal Therapist medical device

About Your Hand/Wrist/Arm Pain and Symptoms
This is a remarkable opportunity for Dr. Walker to perform a medical consultation regarding your condition without any fee or obligation. If it appears the Carpal Therapist will work for you, GREAT! If simple exercises will do the trick, GREAT! If it appears you need surgery -- not so great but the good news is that you'll know more than you do now. Answer the questions thoughtfully to get the best result.
First Name:
Last Name:
Age:
Sex:
Height:
Weight:
Occupation:
Email:
Confirm eMail: *
Please explain exactly what you want to find out about your condition. What is your most burning issue? Most pressing concern?
Be as detailed as you wish:
Please tell me how you found me:
SECTION ONE: Applicable Conditions
If you have been told or diagnosed by a doctor, nurse or therapist that you have any of the following, then please select from the drop-down menu which arm/or select both.
Carpal Tunnel Syndrome
Repetitive Stress Injury (RSI)
Neuropathy
Tendonitis
Gout
Peripheral Vascular Disease
SECTION TWO: About Your Condition(s)
If “yes” to any of the above conditions, how many years ago were you informed? Please specify which disease(s) and which arm(s).
Left
Right
Both
Have you ever had surgery for any of the conditions above? Please specify which condition(s) and how long ago (years and/or months).
Yes, I've had surgery for the following condition(s):
How long ago?
Do you take PRESCRIPTION medication(s) for any of the above and which?
Do you take NON-prescription medication(s) for any of the above and which?
SECTION THREE: About Your Pain
FOR PAIN SENSATION ONLY, on a scale of 0 to 10, where 10 is the most severe: How much pain do you experience?
Left: 0 to 10
Right: 0 to 10
Both: 0 to 10
How often is that pain present?
Once per day
2 - 3 times per day
4 - 6 times per day
Constant
SECTION FOUR: Other Discomforts
FOR OTHER SENSATIONS, LIKE BURNING, TINGLING, NUMBNESS, ETC., on a scale of 0 to 10, where 10 is the most severe: How much discomfort do you experience? Also specify type of sensation.
Left: 0 to 10 and type of sensation:
Right: 0 to 10 and type of sensation:
Both: 0 to 10 and type of sensation:
How often is that discomfort present?
Once per day
2 - 3 times per day
4 - 6 times per day
Constant
SECTION FIVE: Coping Mechanisms (last question!)
Please describe, in one sentence, what you do to best relieve your symptoms, if anything (e.g., if you use splints, ice, physical therapy, etc.).
Left
Right
Both