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5/22/2019SSTM WELLNESS INTAKE DOCUMENT.doc Google Passport and Spine Therapy of Marin Wellness/Transitional/PREP Questionnaire Name Sex Age DOB / / PREP PROGRAM: FOR PREOPERATIVE PATIENTS ONLY: Who
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How to fill out sport and spine formrapy
How to fill out sport and spine formrapy
01
To fill out the sport and spine therapy form, follow these steps:
02
Begin by providing your personal information, such as your name, date of birth, and contact details.
03
Indicate any previous or existing medical conditions or injuries that may be relevant to your therapy.
04
Specify the type of sport or physical activity you participate in and the specific areas of your spine or body that require treatment.
05
Describe any symptoms or pain you are experiencing in detail, including the severity and duration.
06
Provide a brief medical history, including any past surgeries or treatments related to your spine or musculoskeletal system.
07
Mention any medications or supplements you are currently taking.
08
If applicable, provide information about your insurance coverage or payment preferences.
09
Review the completed form for accuracy and ensure all required fields are filled.
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Sign and date the form to affirm its completeness and accuracy.
11
Submit the form to the sport and spine therapy clinic or healthcare provider as instructed.
Who needs sport and spine formrapy?
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Sport and spine therapy may be beneficial for individuals who:
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- Participate in sports or physical activities that place strain on the spine or musculoskeletal system.
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- Have experienced sports-related injuries, such as sprains, strains, or fractures.
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- Suffer from chronic back or neck pain due to spinal conditions or muscular imbalances.
05
- Seek rehabilitation or recovery from spinal surgeries.
06
- Wish to improve their overall spine and musculoskeletal health and performance.
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- Require guidance and treatment for specific spinal conditions, such as scoliosis or herniated discs.
08
- Want to prevent future injuries and optimize their athletic performance through targeted therapy.
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What is sport and spine formrapy?
Sport and spine formrapy refers to specialized therapeutic practices designed to treat injuries and conditions related to the spine and musculoskeletal system through sports medicine techniques.
Who is required to file sport and spine formrapy?
Individuals who participate in sports activities and have received treatment or rehabilitation for spine or musculoskeletal injuries may be required to file sport and spine formrapy.
How to fill out sport and spine formrapy?
To fill out sport and spine formrapy, one must complete specific sections detailing personal information, injury details, treatment received, and any recommended follow-up care.
What is the purpose of sport and spine formrapy?
The purpose of sport and spine formrapy is to document injuries, ensure proper treatment protocols are followed, and facilitate recovery for athletes and individuals involved in sports.
What information must be reported on sport and spine formrapy?
Sport and spine formrapy must report personal details, nature of the injury, treatment dates, type of therapies received, and any ongoing treatment requirements.
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