Day 1 to 3 Progress Form Please enable JavaScript in your browser to complete this form.Name *FirstLastAge Group *--- Select Choice ---60 and overunder 60Email *Confirm Email *Pain Scale & Location description used in this formPain Scale descriptionPain Location descriptionBaseline - pain-level (before these exercises) *--- Select Choice ---0 - no pain1 - 3 mild4 - 6 moderate7 - 10 severeBaseline - pain location (before these exercises *---Select Choice ---1. near the buttock (one side)2. radiating down back leg3. radiating down back foot4. pain centralised – back to middle5. other area of the body6. no more painDay 1 - pain level (at the end of Day 1) *--- Select Choice ---0 - pain free1 - 3 mild4 - 6 moderate7 - 10 severeDay 1 - pain location (at the end of Day 1) *---Select Choice ---1. near the buttock (one side)2. radiating down back leg3. radiating down back foot4. pain centralised – back to middle5. other area of the body6. no more painDay 1 - How many session(s) performed? *---Select Choice ---01 session2 sessions3 sessions4 sessions5 sessions6 sessions7 sessions8 sessionsA single session consists of both Ex A (Cross Leg) and Ex B (Semi Push-Up). Severe pain - Performing two sessions each in the: morning, noon, afternoon and bedtime. Gradually reduce number of sessions when pain subsided.Day 2 - pain level *--- Select Choice ---0 - pain free1 - 3 mild4 - 6 moderate7 - 10 severeDay 2 - pain location *---Select Choice ---1. near the buttock (one side)2. radiating down back leg3. radiating down back foot4. pain centralised – back to middle5. other area of the body6. no more painDay 2 - How many session(s) performed? *---Select Choice ---01 session2 sessions3 sessions4 sessions5 sessions6 sessions7 sessions8 sessionsA single session consists of both Ex A (Cross Leg) and Ex B (Semi Push-Up). Severe pain - Performing two sessions each in the: morning, noon, afternoon and bedtime. Gradually reduce number of sessions when pain subsided.Day 3 - pain level *--- Select Choice ---0 - pain free1 - 3 mild4 - 6 moderate7 - 10 severeDay 3 - pain location *---Select Choice ---1. near the buttock (one side)2. radiating down back leg3. radiating down back foot4. pain centralised – back to middle5. other area of the body6. no more painDay 3 - How many session(s) performed? *---Select Choice ---01 session2 sessions3 sessions4 sessions5 sessions6 sessions7 sessions8 sessionsA single session consists of both Ex A (Cross Leg) and Ex B (Semi Push-Up). Severe pain - Performing two sessions each in the: morning, noon, afternoon and bedtime. Gradually reduce number of sessions when pain subsided.Your message? *Description of your progress in the last three days. Send
