JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Arm pain
If you have arm pain, please fill following details which will help the doctor to analyse your problem better.
Sign in to Google
to save your progress.
Learn more
Please write your name and institution ID ,if any?
Your answer
Is the pain in one or both arms?
One
Both
Sometimes one, sometimes both
Clear selection
Is the pain increased with
Movement of shoulder e.g. when raising the arm .
Movement of neck
Walking briskly or during chewing or cycling fast
Is there associated tingling or numbness in the hand or certain fingers(like the hand sleeping)
Yes
No
Maybe
Clear selection
Is there some skin rash like water filled pimples or reddish lesions over the arm or corresponding shoulder blade area
yes
no
Clear selection
Do you have ?
Diabetes
Blood pressure or Heart disease
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
