Odyssey Questionnaire

Welcome to Odyssey

Let’s start the journey to you regaining your physical freedom through pain free movement. Please take a moment to fill in the information below in as much detail as possible

LETS BEGIN..

Name

First Name

Last Name

Date of Birth

Best Contact Number

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please give an in-depth overview of the specifics of the current or long term injury, pain & or discomfort you are or have been dealing with and for which is the reason for you contacting Odyssey

Please give and in-depth overview of the length of time that this issue has been a problem for yourself

Please give and in-depth overview of within this time what protocols you have tried to fix this issue? (i.e Nothing, Physiotherapy, Chiropractic, Resting, Anti-Inflammatories, Surgery etc)

Please give and in-depth overview of why you think these things haven’t worked for you or have had little long term success

On a scale of 1 - 10, how much of a priority is this for you to fix? (1 = Not at all , 10 = No. 1 priority for my physical & mental health)

Please give an in depth overview of what your main goal is to achieve with this over the next 12 months?

Please give a full list of all the training equipment you have currently at your access to at home (This will assist in the remote programming system of Odyssey)

Do you give consent for Odyssey to use photos or videos of yourself for social media marketing purposes?

Yes

What is your shirt size in a male sizing guide?

Please give in as much detail as possible any more relevant information you see necessary for us to know about yourself