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Referral Form Adult Services *The Interprofessional Clinic is a teaching clinic. As such, most services are offered or observed by students under the supervision of a clinical educator. Fax # 6135267126
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Start by gathering all the necessary information, such as personal details, medical history, and contact information.
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Begin filling out the form by providing your full name, date of birth, and gender.
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In the medical history section, disclose any pre-existing conditions, allergies, or injuries you may have had.
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Next, provide your emergency contact information, including the name, relationship, and phone number of the person to be contacted in case of an emergency.
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If applicable, indicate any medications you are currently taking or have taken in the past.
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Fill out any additional sections or questions pertaining to your physical fitness level, exercise habits, or specific goals for the program.
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Once you have completed filling out the form, review it for any errors or missing information.
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Sign and date the form at the designated space to confirm that the information provided is accurate and complete.
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Submit the form to the relevant authority or institution responsible for the physical therapy program.

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Individuals who are interested in pursuing a career in physical therapy may need to fill out a physical therapy program student form.
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The physical formrapy program student refers to a structured educational curriculum designed for students pursuing a career in physical therapy, encompassing theoretical knowledge and practical skills.
Students enrolled in a physical therapy program and who are seeking credentials or licensure in the field are required to file the physical formrapy program student.
To fill out the physical formrapy program student, students need to provide their personal information, academic history, program details, and any required documentation as specified by the institution.
The purpose of the physical formrapy program student is to document and facilitate the student's journey through the physical therapy curriculum, ensuring compliance with educational and licensing requirements.
The information that must be reported includes personal identification details, program enrollment status, course completion, clinical hours, and any previous education related to physical therapy.
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