UNIVERSITY OF BATH: Shoulder Research project – SURVEY If you are a Tennis Player and would like to participate in our Shoulder Study, please fill in the Questionnaire below and we will contact you with further details. The Questionnaire should take no longer than 10 minutes to complete. Name and Surname Email Phone Number To prevent robots from filling this form, please retype the letters you see in the image above. 1. Gender Male Female 2. Date of Birth (dd/mm/yyyy) 3. Age in Years 4. Preferred location Please select your answer Weybridge Bath 5. Current Level of Competition Club level County level Elite level Other 6. How many hours of tennis do you play per week? (Including on-court training and matches) 7. Years of Playing Tennis 8. Which is your Dominant Hand? Left Right 9. Type of Serve used most frequently Flat Slice Kick Other 10. Do you have any Shoulder Pain? Yes No (If No please proceed to Question 19) 11. Which side is the pain? Left Right Both 12. How much is you Pain Score on a Scale of 0 (no pain) to 10 (extreme pain)? 13. When did the pain start? 14. Do you have Pain at Night? Yes No 15. Can you Serve with your pain? Yes No 16. Did you consult any of these professionals about your shoulder pain? Physiotherapist GP Shoulder Consultant Other None 17. If you have seen someone, what was their Diagnosis? 18. Have you had any Imaging (X-Rays/ Ultra-sound/ MRI) scans taken of your shoulder? Yes No 19. Do you suffer from Cervical Pain? Yes No 20. Do you suffer from Frozen Shoulder? Yes No 21. Do you suffer from Diabetes? Yes No 22. Have you had any Shoulder Surgery in the last 12 months? Yes No 23. Have you had any Shoulder Infiltrations? Yes No Time's up
