Click on the links below to download and complete the appropriate paperwork prior to your arrival. You have the option to fill out the forms electronically and email them to us, or you can print the forms and bring the completed forms with you to your appointment.
Patient Paperwork
Functional Outcome Measurement Paperwork
Please select the appropriate form(s) for the condition(s) we will be treating you for:
- Neck Pain/Injury – NDI (Neck Disability Index)
- Back Pain/Injury – Oswestry Disability Index
- Shoulder, Elbow, Wrist Pain/Injury – Quick DASH
- Hip, Knee, Ankle, and Foot Pain/Injury - LEFS
- Dizzyiness Handicap Inventory - Initial Visit
- Modified Falls Efficacy Scale (MFES) - Initial Visit
If you would rather print out and fill out the forms please click each pertinent form to download and print it out:
- Patient Information
- Patient Health Questionnaire
- Consent to Treatment
- Neck Pain/Injury – NDI
- Back Pain/Injury – Oswestry Disability Index
- Shoulder, Elbow, Wrist Pain/Injury – Quick DASH
- LEFS: Hip, Knee, Ankle, and Foot Pain/Injury
TeleRehab Paperwork