Injury Pain Form

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Swear Nutrition

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If you’re dealing with pain, discomfort, or anything that doesn’t feel quite right, this form helps me understand what’s going on so I can adjust your training and support you better.

Please be as specific as you can — even if it feels minor. This helps me keep you moving safely and make a plan that works for your body.

Injury/Pain Form

Name *

First

Date

Are you currently experiencing any pain or discomfort?

Pain

Discomfort

Where does it hurt?

Describe what you're feeling

Sharp pain

Dull ache

Tight/stiff

Tension

Burning

Numbness or tingling

Pressure

Pinching

Throbbing

Cramping

Soreness

Fatigue/weakness

Unstable / joint feels like it might give out

Limited range of motion

Locking / catching

Popping or clicking (with or without pain)

OtherOther

On a scale of 1-10, how bad does it hurt?

1

2

3

4

5

6

7

8

9

10

When did it start?

Do you know what caused it, or did it just show up?

What makes the pain feel worse?

What (if anything) makes it feel better?

Have you seen a medical provider about this?

Yes

No

If yes, what was their diagnosis?

. Does this pain limit your ability to perform daily tasks, work, or exercise?

Yes

No

Sometimes

Training Considerations

Are there any movements or exercises you’re currently avoiding?

Is there anything specific you’d like me to know so we can train around or rehab this safely?

Would you like me to follow up with:

A movement screen

A corrective exercise plan

A referral to a chiropractor or physical therapist

Just modify training for now

If you are human, leave this field blank.

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