Patient Forms

In order for us to save time and provide you with the best care possible, please download, print and fill out:
1. The Consent Form
2. Patient Information
3. One Questionnaire corresponding to the body part bothering you.

Also bring:
4. Updated list of current medications
 5. Your doctor’s order for therapy, as required by your insurance

Bring these filled out papers to your 1st physical therapy visit and the receptionist or PT will gladly take it from you.

  1. Consent Form
  2. Patient Information
  3. Neck Index: If you have neck pain or pain radiating from your neck into your shoulder or arms fill out the link below:
    Neck QuestionnaireHand/Arm/Shoulder Questionnaire: If you have shoulder, arm or hand pain.

     

    Low Back Index: If you have low back pain and or pain radiating down your back/buttock/legs fill out the link below: Back Index

    Foot/Ankle/Leg/Knee/Hip Questionnaire: If you have hip, knee, leg or foot pain fill out the link below:
    Foot Ankle Knee Hip Questionnaire

    If you have jaw pain, please print and fill out the link below:
    Jaw Pain Questionnaire

    If you are experiencing dizziness, please print and fill out the link below: Dizziness_Handicap_Inventory

    If you are experiencing headaches, please print and fill out the link below: HIT-6       Headache form

One thought on “Patient Forms”

  1. Are you familiar with and provide Orofacial Myofunctional Therapy for the treatment of sleep apnea? There is a book by Carol Vander-Stoep (author of the book “Mouth Matters; How Your Mouth Ages Your Body and What YOU Can Do About It”), is a leading expert in this form of this therapy. It would help so many who cannot tolerate a cpap.

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