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Find My Cause

Breakthrough Pain & Performance

Your Story - Before We Meet

Please complete this form to give me the bigger picture of your problem, your history and the challenges you're facing, so we can work towards resolving your issues for good.

This usually takes 10-15 minutes. Please be as detailed as you can, the more I know going in, the better the bigger picture I can build before your first session. Your responses are sent securely and treated as strictly confidential.

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1

Your Contact Details

2

About Your Issue

3

Pain Characteristics

4

Movement Habits

5

Pain & Discomfort Scale

6

About You

7

Medical History

8

Trauma, Procedures & Birth History

9

Lifestyle & Background

10

Your Goals

Your responses are sent securely to Sam at Breakthrough Pain & Performance and used only for your assessment.