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Back Pain Systems™ On-Boarding Form

Congratulations and Welcome!

Dr. Jo Abbott’s Back Pain Systems 8 Week RESET Challenge On-Boarding Form

Join Dr Jo Abbott’s Back Pain Systems 8-Week Back Pain Challenge! Transform your back health, regain mobility, and say goodbye to pain—starting today! Apply Now to Take Part: We’re excited to guide you on this journey to better back health. Complete the form below to apply for your position. Once you submit your application, Dr Jo will review it and reach out within 48 hours to discuss your goals and confirm your participation.

PERSONAL DEMOGRAPHICS

Full Name(Required)
Preferred Name (if different)(Required)
Email(Required)
What phone do you have?(Required)
Preferably a mobile phone number you use for WhatsApp.
Address(Required)

BACK PAIN EXPERIENCES

Tell Us About Your Back Pain
How long have you experienced back pain for?(Required)
Where is your pain located?(Required)
How would you describe your pain?(Required)
0 – no pain and 10 – unbearable pain
Please enter a number from 0 to 10.
What causes or worsens your pain? (Tick all that apply)(Required)
What helps relieve your pain? (Tick all that apply)(Required)
Have you been diagnosed with any of the following? (optional)
Have you seen a healthcare provider for your pain?
For example, treatments, surgery, exercises, etc.?
Are you on any medication?(Required)
For example; washing my hair or standing in the kitchen or brushing teeth etc.

BELIEFS AND FEARS

Do you avoid activity because of pain?(Required)
Do you fear movement will make your pain worse?(Required)
Do you believe your back pain can improve?(Required)

PERSONAL GOALS AND INTENTIONS

For example; I need to gain control of my life, or I have my son’s wedding in 6 months time.
What are you most hoping to get out of this challenge?

YOUR COMITTMENT

Do you have 5 hours every week to commit to this challenge?(Required)
Do you have £495 (saving £2505) to commit and invest in this challenge?(Required)

HEALTH CHECK

OPTIONAL RESEARCH DATA POINTS

To support long-term case study or cohort analysis
Occupation or lifestyle
How many days have you taken sick leave for back pain in the last 12 months?
Prior to starting the 8 Week RESET Challenge
Have you tried any of the following before?
Are you willing to share anonymous progress data for research?
Consent
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