College of Health Sciences

Shoulder Research Center Screening Questionnaire

Please complete the questions below to determine if you are eligible for participation in our current shoulder study. Your personal information will be kept confidential and protected in accordance with HIPPA regulations. Thank you for your interest.

Shoulder History

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On a scale of 0-10, how would you rate your level of pain?
Screening Questions

Please add any additional information here related to any of the questions above.

Contact and Background Information

(lbs.)

(ft., in.)