Get the free pt intake form - Dr Flora Levin
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Patient Intake Form Welcome To Our Office. All information will be kept confidential. Please print clearly and complete all items fully. Last Name: First : Preferred name/ nickname Single Married
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How to fill out pt intake form
How to fill out pt intake form
01
Start by reading the instructions on the PT intake form carefully.
02
Provide your personal information, including your name, address, phone number, and email.
03
Answer the questions regarding your medical history, including any current medications you are taking.
04
Specify any previous injuries or surgeries you have had.
05
Indicate your goals and expectations from the physical therapy sessions.
06
Describe any pain or discomfort you are currently experiencing, and mention the activities that worsen or alleviate the pain.
07
Include any additional information that may be relevant to your physical therapy treatment.
08
Sign and date the form to certify that the information provided is accurate.
Who needs pt intake form?
01
Anyone who is seeking physical therapy treatment needs to fill out a PT intake form. This form is necessary for the therapist to gather important information about the patient's medical history, current condition, and treatment goals. It helps the therapist understand the patient's needs and develop an appropriate treatment plan.
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