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! ! ! ChildHistoryFormDr. JasonPriceDr. TaraPriceDr. Rob Green nn368 Phillip St. Waterloo, ON N2L 5J1 Phone: 519.885.5433 Fax: 519.885.3155 www.pricehealth.caAt Price Health Center our goals are to

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How to fill out physio new patient intake

01

Start by collecting basic information from the patient, such as their full name, date of birth, and contact details.

02

Ask about their medical history, including past injuries, surgeries, and any existing medical conditions.

03

Inquire about the specific reason for their physiotherapy visit and any symptoms they are experiencing.

04

Request information about their current medications and any allergies they may have.

05

Have the patient fill out a questionnaire regarding their lifestyle, occupation, and physical activities.

06

Ask about their insurance coverage and if they require any additional referral or authorization for treatment.

07

Obtain their signature consenting to the treatment and acknowledging the clinic's policies and procedures.

08

Provide the patient with any additional forms or documents required by the clinic for record-keeping purposes.

09

Finally, review the completed intake form with the patient, ensuring all information is accurate and addressing any questions or concerns they may have.

Who needs physio new patient intake?

01

Any individual seeking physiotherapy treatment for the first time or switching to a new physiotherapist may need to fill out a new patient intake form. This includes patients with acute or chronic injuries, post-surgical rehabilitation, or those seeking preventive or maintenance care. The intake form helps physiotherapists gather necessary information about the patient's medical history, current condition, and goals to provide appropriate and personalized treatment.

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