Patient Forms

Before your first visit, please fill out the patient history form below as well as any forms that pertain to the area of your body being treated. Bring these completed forms with you to save yourself from having to fill them out upon arrival.

Example A:
You are coming in to be treated for your back pain. Fill out the patient history form and the back index form.

Example B:
You are coming in to be treated for dizziness. Fill out the patient history form and the Dizziness Handicap Inventory, Falls Efficacy, and Activities Specific Balance Scale.

Patient Forms

Patient History Form

Arm, Shoulder, and Hand Form

Hip, Knee, Ankle, and Foot Form

Neck Form

Back Form

Dizziness Handicap Inventory Form

Activities Specific Balance Scale Form

Falls Efficacy Form