Makati, Philippines
(+63) 922 538 9680
Makati, Philippines
Viber / WhatsApp
(+63) 922 538 9680
chosenwellcare@gmail.com
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Orthopedic Assessment
Orthopedic Assessment
Step
1
of
3
33%
General Data
Name
(Required)
First
Middle Initial
Last
SS Number
(Required)
Time Zone / Location
(Required)
(GMT -12:00) Eniwetok, Kwajalein
(GMT -11:00) Midway Island, Samoa
(GMT -10:00) Hawaii
(GMT -9:30) Taiohae
(GMT -9:00) Alaska
(GMT -8:00) Pacific Time (US & Canada)
(GMT -7:00) Mountain Time (US & Canada)
(GMT -6:00) Central Time (US & Canada), Mexico City
(GMT -5:00) Eastern Time (US & Canada), Bogota, Lima
(GMT -4:30) Caracas
(GMT -4:00) Atlantic Time (Canada), Caracas, La Paz
(GMT -3:30) Newfoundland
(GMT -3:00) Brazil, Buenos Aires, Georgetown
(GMT -2:00) Mid-Atlantic
(GMT -1:00) Azores, Cape Verde Islands
(GMT) Western Europe Time, London, Lisbon, Casablanca
(GMT +1:00) Brussels, Copenhagen, Madrid, Paris
(GMT +2:00) Kaliningrad, South Africa
(GMT +3:00) Baghdad, Riyadh, Moscow, St. Petersburg
(GMT +3:30) Tehran
(GMT +4:00) Abu Dhabi, Muscat, Baku, Tbilisi
(GMT +4:30) Kabul
(GMT +5:00) Ekaterinburg, Islamabad, Karachi, Tashkent
(GMT +5:30) Bombay, Calcutta, Madras, New Delhi
(GMT +5:45) Kathmandu, Pokhara
(GMT +6:00) Almaty, Dhaka, Colombo
(GMT +6:30) Yangon, Mandalay
(GMT +7:00) Bangkok, Hanoi, Jakarta
(GMT +8:00) Beijing, Perth, Singapore, Hong Kong
(GMT +8:45) Eucla
(GMT +9:00) Tokyo, Seoul, Osaka, Sapporo, Yakutsk
(GMT +9:30) Adelaide, Darwin
(GMT +10:00) Eastern Australia, Guam, Vladivostok
(GMT +10:30) Lord Howe Island
(GMT +11:00) Magadan, Solomon Islands, New Caledonia
(GMT +11:30) Norfolk Island
(GMT +12:00) Auckland, Wellington, Fiji, Kamchatka
(GMT +12:45) Chatham Islands
(GMT +13:00) Apia, Nukualofa
(GMT +14:00) Line Islands, Tokelau
Birthday
(Required)
MM slash DD slash YYYY
Current Age
(Required)
Please enter a number from
18
to
110
.
Phone Number
(Required)
Where to contact for online consult
Viber
WhatsApp
Branch of Military
(Required)
Army
Marine Corps
Navy
Air Force
Space Force
Coast Guard
Year Started in Military
(Required)
Year Ended in Military
(Required)
Number of Years in Military
(Required)
Job or Role while in Military
(Required)
Left or right handed?
Left Handed
Right Handed
1st Musculoskeletal area for evaluation
What incident or activities in your job/role during your service might have put you at risk to develop problems in the area to be evaluated?
(Required)
Please explain
(Required)
What activities/movements are now difficult because of the pain and discomfort in the area to be evaluated?
(Required)
Please explain
(Required)
2nd Musculoskeletal area for evaluation
What incident or activities in your job/role during your service might have put you at risk to develop problems in the area to be evaluated?
(Required)
Please explain
(Required)
What activities/movements are now difficult because of the pain and discomfort in the area to be evaluated?
(Required)
Please explain
(Required)
Have you had any surgeries or been advised for surgery for any of the areas that will be evaluated?
Type of Surgery
Date of Surgery
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