General and Medical History What is your current occupation? Does your occupation require extended periods of sitting? Yes No Does your occupation require repetitive movements? Yes No If yes, please specify Does your occupation require you to wear shoes with a heel (e.g., dress shoes)? Yes No Does your occupation cause you mental stress? Yes No Have you ever had any injuries or chronic pain? Yes No If yes, please specify Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? Yes No If yes, please specify Are you currently taking any medication? Yes No If yes, please specify If there is any other addition information you would like to let us know please write here Thank you!
