Who Can Benefit From Physical Therapy?

Physical therapy can help any age group with:

  • Low back pain
  • Neck pain
  • Shoulder and arm pains
  • Sprains and strains
  • Arthritis
  • Cardiac Rehabilitation
  • Rehabilitation after a serious injury
  • Pediatric concerns
  • Stroke Rehabilitation
  • Problems with balance and falls
  • Pre/postnatal programs
  • Hip fractures
  • Pre and post surgical rehabilitation
  • Sport and work related injuries

Medical History Form

In order for us to service your needs best please provide accurate detailed medical/surgical history below.

Name

Email
Date
Present Medical Concerns:
Medications:
Allergies:

Personal Medical History
Please include whether you have had, or currently have any of the following medical problems.

Heart Disease
Heart Attack
High Blood Presure
Diabetes
High Cholesterol
Thyroid Problem
Bleeding/clotting problem
Cancer
Stroke
Anemia
Arthritis
Asthma
Amputation (year)
Autoimmune Disease
Depression
Genetic Disorders
Kidney Disease
Osteoporosis
Epilepsy (seizure disorder)
Substance Abuse
Tuberculosis
Smoking


Please indicate here, any illnesses not listed:


Surgical History: