In Motion Physical Therapy
& Prevention - Patient Forms

These are the forms you will need to print and fill out to bring to your first appointment. If you bring these completed forms with you on your initial visit it will greatly speed up your registration process.

These forms require the free Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader you may get a copy here.

If you are unable to print these forms you may fill these out upon your arrival at our clinic.

All patients will need to print and fill out this form.

Pain and Sympton Survey


Back Index

If you have low back pain, sciatica (leg pain radiating from back or hip) or hip pain, please print and fill out this form and bring it on your initial visit.

Back Index Form


Neck Index

If you have neck pain and/or pain radiating down arm and/or into your hand, please print and fill out this form and bring it on your initial visit.

Neck Index Form


LEFS

If you have localized ankle/foot or knee pain please print, and fill out this form and bring it on your initial visit.

LEFS Form


DASH

If you have localized pain with your shoulder, elbow, wrist or hand, please print and fill out this form and bring it on your initial visit.

DASH Form