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3959 Roughing Road, Suite F San Diego, CA 92123 Phone (858) 279-5570 Fax (858) 279-5303 Bryan Hill PT, Rehab Director Sean Hill, MPT, CSS, Pediatric Director Rehabilitation Referral Patient s Name
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How to fill out complete physical formrapy:

01
Start by entering your personal information, such as your name, date of birth, and contact details. This is important for identification purposes and for the healthcare provider to reach out if needed.
02
Next, provide your medical history, including any previous illnesses, surgeries, or chronic conditions you may have. It is important to be thorough and include all relevant information to ensure accurate assessment and treatment.
03
Indicate any allergies or adverse reactions to medications. This information is crucial for preventing any potential complications or adverse reactions during the physical therapy sessions.
04
Describe your current symptoms or specific areas of concern that you would like to address in the physical therapy sessions. This will help the healthcare provider tailor the treatment plan to meet your specific needs.
05
If you have any relevant imaging reports or medical documents, make sure to bring copies and provide them to the healthcare provider. These will assist in the diagnosis and treatment planning processes.
06
Lastly, sign and date the form to authenticate the information provided and give consent for the physical therapy treatment.

Who needs complete physical formrapy?

01
Individuals recovering from injuries or surgeries that require physical rehabilitation to regain strength, mobility, and function.
02
Athletes looking to improve their performance, prevent future injuries, or manage existing ones.
03
Individuals with chronic pain or conditions, such as arthritis or fibromyalgia, who can benefit from physical therapy interventions to alleviate symptoms and improve quality of life.
04
Older adults who may experience age-related decline in mobility, balance, or strength and can benefit from physical therapy to maintain independence and prevent falls.
05
Individuals with neurological conditions, such as stroke or Parkinson's disease, who require physical therapy to regain movement and improve coordination.
06
People with posture-related problems, work-related injuries, or repetitive strain injuries may also require physical therapy to address these issues and prevent further complications.
Note: It is important to consult with a healthcare professional or a physical therapist to determine if physical therapy is appropriate for your specific needs and to receive personalized advice and recommendations.
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