To help CEED prepare and get the most out of our initial assessment video call please complete and submit the following information.

Please note that personal details are being requested for medical/health records that are mandatory for medical practitioners to maintain. All information provided through this page is secure, confidential and will not be redistributed without consent.

* If under 18 please ensure a parent or guardian is available to attend the video assessment call.

Do you have a current injury?

Describe the sensation:

0 = No Pain, 10 = Worst pain possible

What rehab equipment do you have access to?