Thursday, July 27, 2017

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Forms

The forms below are needed for every new patient. Please read carefully to see which forms you need and take them with you to your first appointment, this will help speed up your initial time in the office.

Your First Appointment

Please arrive 15 minutes early to your first appointment and bring:

  • Your insurance information and cards
  • Identification
  • Physician prescription, referral or order
  • New Patient Forms and Disability/Pain Index listed below

We ask that you:

  • Attend your scheduled sessions
  • Participate with your treatment each session
  • Follow through with your Home Exercise Program

You may also want to bring:

  • Loose comfortable clothes
  • Socks and sneakers
  • Bathing suit if going into the pool

New Patient Forms

Print one from the selection below. All patients MUST print out one of the following packets. Please print ONLY 1 packet and take it with you to your first appointment.


Disability/Pain Indexes and Scales

Download the appropriate form that pertains to your injury. The prupose of forms below are to identify difficulties that you may be experiencing. Please print out only the forms needed and take it with you to your first appointment.

  • Headache Disability Index - Help us identify headache problems.
  • Lower Extremity Functional Scale - We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention.
  • Lower Back Disability Index -This questionnaire has been designed to give the doctor information as to how your back pain has affected your ability to manage in everyday life.
  • Neck Disability Index - This questionnaire has been designed to give the doctor information as to how your neck pain has affected your ability to manage in everyday life.
  • Upper Extremity Functional Scale- We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention.

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