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Frozen Shoulder Specialists · Patient Assessment

Frozen Shoulder Suitability Assessment

Complete this short assessment so our medical team can better understand your shoulder symptoms, range of motion, imaging history, and previous care — and determine whether you may be an appropriate candidate for a complimentary physician video consultation.

During the video consultation, the physician will review your shoulder movement, discuss your imaging if available, and determine whether your condition appears suitable for treatment.

8–10 minutes No imaging or videos required today Submitted securely

What Happens Next

1

Complete this assessment

Tell us about your shoulder symptoms, movement, imaging, and previous treatment.

2

Clinical review

Our team reviews your information to determine whether your symptoms appear consistent with frozen shoulder.

3

Physician video consultation

If appropriate, we will arrange a video consultation with a physician to review your movement and imaging.

Frozen Shoulder Suitability Assessment Form

Please provide your basic information so our team can contact you about the next step.

Please briefly describe the physical demands of your job, especially any lifting, reaching, overhead work, computer work, driving, or duties affected by your shoulder.

These questions help us understand whether your symptoms are consistent with frozen shoulder.

0 = no pain10 = worst imaginable pain
0 = no pain10 = worst imaginable pain

Please answer based on what you can do today. You do not need to be exact. These questions help the physician understand how restricted your shoulder movement may be.

Raising the arm straight in front of you
Raising the arm out to the side
Seen from above. Your elbow stays pinned to your side — only the forearm swings outward.
How to test: Tuck your upper arm against your side and bend your elbow to a right angle, forearm pointing straight ahead — as if holding a tray. Now, without letting your elbow leave your side, swing your hand outward, away from your stomach. Your elbow is the hinge, like a gate swinging open.
Reaching up behind your back
Placing your hand behind your head

These questions help us understand how your shoulder affects daily life and what care you have already tried.

How difficult are these because of your shoulder?

Example: sleep, work, dressing, exercise, sports, driving, pain, loss of independence, or daily activities.
If you have imaging reports available, you can upload them in the final step. If you do not have imaging today, you can still submit this assessment.
No imaging yet? No problem - you can still submit this assessment and the physician will advise on next steps.

These questions help identify anything the physician should review before your consultation.

Optional, but recommended.

Address & Logistics

Please provide your current mailing address. This helps our team coordinate consultation logistics, regional communication, documentation, and next steps if your assessment moves forward.

Imaging and Medical Reports (Optional)

You can submit your assessment without imaging.

If you have scans or medical reports ready on your device, please upload them below. If you don’t, leave this section blank and submit your form now. Our team will let you know if anything else is needed.

Your information is submitted securely and reviewed only for the purpose of assessing your shoulder condition and arranging appropriate next steps.

Start Your Free Clinical Assessment

Explore ACM, a non-surgical frozen shoulder treatment option. Begin with a free video assessment. Submitting this form does not commit you to treatment.