Health Surveys-
1.Age 10-15 21-30 41-50 61-70 Greater than 80 16-20 31-40 51-60 71-80 -
2.Gender Male Female -
3.Hand dominance Right Left -
4. If you have any shoulder problems at all, which side is problematic? Right Left Both Not Applicable -
5.Do you smoke? Yes No -
6. If you smoke, how many packs per day? Not applicable 0-1 Greater than 1,less than 2 Greater than 2,less than 3 Greater than 3 How long have you smoked? 0-1 year 1-2 years 2-5 years 5-10 years 10-15 years Greater than 15 years -
7. Did you play or do you play? Little league football High school football Professional football Junior or intermediate school football College football Not applicable -
8. What kind of work have you primarily done in your life? Sedentary (no lifting or occasional lifting of light objects) Active (frequent lifting of heavy objects) Normal (occasional lifting of light to moderately heavy objects) Strenuous (constant lifting of heavy objects ) Moderately active (occasional lifting of heavy objects) -
9. Do you workout with upper body weights? Never Twice a week More than three times per week Once a week Three times a week -
10.Have you ever sustained a shoulder injury that prevented you from working or participating in activities of daily living or recreation? Yes No
| �����ż���͡Ẻ�ͺ����͹�Ź� | ||
|---|---|---|
| ���� | : | |
| e-mail* | : | |