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Franklin Square Physical Therapy Patient Intake Form Name Address City Home Phone # Date of Birth Email Address Employer Marital Status S M D W Emergency contact name? Referring M.D. Social Sec #
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How to fill out Franklin Square physical therapy form:

01
Begin by providing personal information: Enter your full name, address, phone number, and email address in the designated fields. Make sure to double-check for any spelling errors.
02
Proceed with insurance details: If you have insurance coverage, fill in the necessary information, including your insurance provider's name, policy number, and group number. If you don't have insurance, leave this section blank.
03
Medical history section: Answer the questions regarding your medical history. Be honest and provide accurate information about any pre-existing conditions, surgeries, or medications you're currently taking.
04
Current issues and symptoms: Describe in detail the reason for seeking Franklin Square physical therapy. Explain any pain, discomfort, or limitations you are experiencing and how it affects your daily life. This information helps the therapist understand your concerns.
05
Previous treatments: Indicate any previous treatments and therapies you have undergone for your current condition. This includes other physical therapy sessions, surgeries, or alternative treatments. If applicable, state the duration and outcomes of these treatments.
06
Allergies and medications: Disclose any known allergies or sensitivities you have to medications, latex, or other substances. Additionally, provide a comprehensive list of your current medications, dosages, and frequency.
07
Emergency contact information: Provide the name, relationship, and contact details of a person who should be contacted in case of an emergency during your physical therapy sessions.

Who needs Franklin Square physical therapy?

01
Individuals recovering from surgery: Many people require physical therapy to regain strength, flexibility, and mobility after undergoing a surgical procedure. Frankin Square physical therapy can facilitate a smooth and steady recovery process.
02
Patients with chronic pain: Those experiencing chronic pain, such as back pain, joint pain, or arthritis, may benefit from Franklin Square physical therapy. The specialized exercises and techniques used can help alleviate pain and improve functionality.
03
Athletes and sports enthusiasts: Whether you're a professional athlete or involved in recreational sports, physical therapy at Franklin Square can assist in preventing injuries, managing sports-related conditions, and enhancing performance.
04
People with musculoskeletal issues: Individuals with musculoskeletal disorders or conditions like fibromyalgia, osteoporosis, or scoliosis can find relief through Franklin Square physical therapy. Targeted treatments can help manage symptoms and improve overall well-being.
05
Acute injuries: Those recovering from acute injuries, such as fractures, sprains, or strains, can benefit from Franklin Square physical therapy. The therapy sessions aid the healing process and prevent long-term complications.
Remember, the information provided here is for guidance purposes, and it's essential to consult with a healthcare professional or your specific physical therapist for accurate instructions and personalized advice.
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Franklin Square Physical Therapy is a healthcare service that provides rehabilitation and treatment for individuals recovering from injuries or surgeries.
Individuals who have been prescribed physical therapy by their healthcare provider are required to file for Franklin Square Physical Therapy.
To fill out Franklin Square Physical Therapy, you need to provide your personal information, medical history, and details of your injury or condition.
The purpose of Franklin Square Physical Therapy is to help patients regain strength, mobility, and function after an injury or surgery.
Information such as patient's personal details, medical history, current condition, treatment plan, and progress must be reported on Franklin Square Physical Therapy form.
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