* 1. Are you a grand parent?

* 2. Are you currently involved in childcare?

* 3. if yes, how many hours a week? Please tick.

* 4. Are you male or female?

* 5. Your age is?

* 6. Work status?

* 7. If yes, what type of work do you currently do?

* 8. How was most of your working life spent?

* 9. Do you experience pain?

* 10. If yes, where in the body (tick more than one if relevant)?

* 11. If yes, how long have you had this?

* 12. If yes, do you think the pain is aggravated by childcare?

* 13. If yes, do you feel that the pain is due to childcare?

* 14. Have you tried any of the following, and if yes, how much did it help?

  Tick if tried Significant improvement Moderate improvement Minor improvement No improvement
Chiropractic
Osteopathy
GP
Medication
Rest
Exercise
Massage
Acupuncture
Podiatry/Chiropody
Injection
Surgery
Physiotherapy
Other

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