Get the free Shoulder Intake Form - Fondren Orthopedic Group

Patient Name: Referred by: Appointment date: (Doctor s name and phone #) CHIEF COMPLAINT Which shoulder is painful? Right Left Both shoulders equal Right more painful than Left more painful than Right

How to fill out shoulder intake form

How to fill out a shoulder intake form?

1. Start by providing your personal information such as your name, age, gender, and contact details.
2. Describe any current shoulder pain or discomfort you may be experiencing. Include details about the onset, duration, and intensity of the pain.
3. Mention any previous injuries or surgeries related to your shoulders, and provide relevant medical records or documentation if available.
4. Indicate any specific activities or movements that aggravate or alleviate your shoulder pain.
5. Include information about your occupation and any repetitive tasks or physical demands that may contribute to your shoulder issues.
6. Mention any previous treatments or therapies you have tried for your shoulder problems and provide details about their effectiveness.
7. Be honest and thorough when answering questions about your overall health and any medical conditions you may have, as they can impact your shoulder health.
8. Consider mentioning any medications or supplements you are currently taking that may affect your shoulder condition.
9. Finally, sign and date the form, acknowledging that the provided information is accurate to the best of your knowledge.

Who needs a shoulder intake form?

1. Individuals who are experiencing shoulder pain or discomfort and seek professional evaluation and treatment for their condition.
2. Patients visiting orthopedic doctors, physiotherapists, chiropractors, or any healthcare professionals specializing in shoulder-related issues.
3. Athletes, particularly those involved in sports that heavily rely on shoulder movements, who may want to address and prevent potential shoulder injuries.

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What is shoulder intake form?

The shoulder intake form is a document that collects information about the condition and history of a patient's shoulders.

Who is required to file shoulder intake form?

The shoulder intake form is typically required to be filled out by patients who have shoulder pain or are seeking medical or physiotherapy treatment for shoulder-related issues.

How to fill out shoulder intake form?

To fill out the shoulder intake form, you need to provide accurate and detailed information about your shoulder condition, medical history, symptoms, and any previous treatments or surgeries related to your shoulders.

What is the purpose of shoulder intake form?

The purpose of the shoulder intake form is to gather necessary information about a patient's shoulder condition and history, which helps medical professionals assess and provide appropriate treatment or care.

What information must be reported on shoulder intake form?

The shoulder intake form typically requires information such as personal details, medical history, current medications, previous treatments, symptoms, pain levels, and any limitations or difficulties experienced with shoulder movements.