History and Intake Form PDF

A practical intake form for recording the history, symptom behaviour and wider context of a person presenting with a painful, stiff shoulder.

What this resource covers

• Onset, duration and progression of symptoms
• Pain location, severity, night pain and sleep disruption
• Movement, work and everyday activity limitations
• Relevant medical history and associated risk factors
• Previous investigations, treatment and patient priorities

Designed for: appropriately qualified healthcare professionals conducting an initial shoulder consultation.

Format: free one-page printable PDF (US Letter).

Professional-use note: Adapt the form to your setting, local record-keeping requirements and professional obligations. It does not replace a complete clinical history or examination.