Formulário de contato – Carpal Tunnel Surgery

Don't Let Cost Stop You From Getting Relief.

Fill out the form and our team will be in touch within one business day to discuss your eligibility.

First Name

Last Name

Phone Number

Date of Birth

Email

State / Territory

Postcode

Describe your symptoms

How did you hear about us?

Which hand(s) are affected by your symptoms?

Right hand only Left hand only Both hands

Which symptoms do you experience? (Select all that apply)

Which fingers are affected? (Select all that apply)

How long have you been experiencing these symptoms?

Less than 3 months 3-6 months 6-12 months More than 12 months

Funding bodies typically require symptoms of >=3 months duration with documented conservative treatment trial.

Are your symptoms worse at night or do they wake you from sleep?

Yes, frequently Yes, occasionally No

Do your symptoms improve when you shake or flick your hand(s)?

Yes No Unsure

On a scale of 0-10, how would you rate your average symptom severity over the past 4 weeks? (0 = no symptoms, 10 = worst imaginable)

How significantly do your symptoms affect your ability to perform the following? (Rate each: None / Mild / Moderate / Severe)

Grip / gripping objects:

Fine motor tasks (buttons, writing):

Work / occupational duties:

Driving:

Sleep:

Daily self-care:

Have your symptoms caused you to reduce or cease work, hobbies, or daily activities?

Yes — significantly Yes — partially No

Funding bodies generally require evidence of failed conservative management prior to surgical approval. Please answer the following carefully.

Have you used a wrist splint for your symptoms?

Yes — currently using Yes — previously used No

Splinting (particularly nocturnal) is a first-line conservative measure. Document duration and compliance.

If yes to the last question, for how long did you use the splint?

Less than 6 weeks 6-12 weeks More than 12 weeks N/A

Have you received a corticosteroid (cortisone) injection into the carpal tunnel for this condition?

Yes No

Injection response (or failure) is relevant to both diagnosis and funding justification.

If yes to previous question, did the injection provide relief?

Yes — lasting relief (>3 months) Yes — temporary relief only No relief N/A

Have you undergone physiotherapy, occupational therapy, or hand therapy for this condition?

Yes No

Have you had a nerve conduction study (NCS) or electromyography (EMG) for this condition?

Yes No Scheduled / pending

NCS/EMG confirmation of median nerve conduction delay is required by most funders. Ensure results are attached to the referral.

If yes to the previous question, what were the findings?

Have you had an ultrasound of the wrist or carpal tunnel?

Yes No

Have you had any prior surgery to either wrist or hand?

Yes — describe below No

Details (optional):