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Disc Recovery Programme Application

To ensure our specialist programme is appropriate for you, we invite you to complete this short pre-assessment suitability questionnaire. 

 

This allows our clinical team to understand your situation and determine whether the Devon Disc Centre’s recovery programme is likely to be the right next step for you. 

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Once we have reviewed your details we will contact you to give you more information and discuss the next steps. 

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Our aim is always to recommend the most appropriate care, whether that is within our centre or elsewhere.

Date of Birth:
Day
Month
Year

Section 1 - Your Situation

1.) Which of the following best describes your current condition?
2.) How long have you been experiencing these symptoms?
3.) Have you previously had any of the following?

Section 2 - How Your Condition Behaves

4.) Many spinal disc conditions have a recognisable pattern.

Please select any that apply:

Section 3 - Current Function

5.) How much does your condition affect your daily life?
6.) Overall, how much is your condition limiting your quality of life?

Section 4 - Health History

7.) Please indicate whether any of the following apply:

Section 5 - Programme Suitability

Our Disc Recovery Programme involves a structured course of care over several weeks.

8.) Please indicate if the following are true for you:

9.) Final Question

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