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Pelvic girdle questionnaire pdf

Pelvic girdle questionnaire pdf 2026

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The document is a pelvic girdle questionnaire designed for patients experiencing pelvic girdle pain. It includes a series of activities to assess the extent to which pain affects daily functions, such as dressing, standing, walking, and engaging in sports. The questionnaire also evaluates pain levels at different times of the day and its impact on mobility and sleep.

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Click ‘Get Form’ to open the pelvic girdle questionnaire in the editor.
Begin by entering your name and the date at the top of the form. This personal information is essential for your physiotherapy records.
For each activity listed, assess how problematic it is for you due to pelvic girdle pain. Tick the box that best describes your current experience, ranging from 'Not at all' to 'To a large extent'.
If any activities are not applicable, write 'N/A' in the appropriate row to ensure clarity in your responses.
Next, indicate your pain levels during morning and evening by selecting from the provided options.
Finally, answer questions regarding how pelvic girdle pain affects your daily activities and sleep patterns by ticking the relevant boxes.

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Versions	Form popularity	Fillable & printable
2015	4 Satisfied (31 Votes)

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