Ankle Question Title * 1. Please enter your full name: Question Title * 2. Date of Birth: Question Title * 3. When did your pain or injury begin? Question Title * 4. What happened? If you sustained an injury, what was the mechanism? Question Title * 5. Where is your pain located? Front of the ankle (anterior) Inside (medial) Outside (lateral) Back of the ankle (posterior) Deep inside the ankle Superficial, just under the skin Other (please specify) Question Title * 6. Is the pain increasing, decreasing, or staying the same since it began? Increasing Decreasing Same Question Title * 7. What activities are you unable to perform due to pain or dysfunction? Question Title * 8. What previous treatment have you received for this problem? Rest, Ice, Compression, or Elevation Over-the-counter medication Prescription Anti-inflammatory medication Prescription Narcotic (Pain) medication Physical therapy Injections Brace Boot or Cast Surgery Other (please specify) Question Title * 9. At what email address would you like to be contacted? Question Title * 10. If you would like us to contact you by phone, please provide the best number to reach you: Done