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Physical Therapy & Wellness 3440 Bell Street, Suite 306 Amarillo, Texas 79109 8068039165 Fax 8063316085 www.ipowpt.com Name: ___Date of Birth: ___Diagnosis: ___ Evaluate & TreatRedcord (neuromuscular
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Gather necessary personal information including name, age, contact details.
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Indicate the reason for seeking physical therapy wellness.
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Provide a detailed medical history, including any past injuries or surgeries.
04
List current medications and any allergies.
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Describe symptoms, including their duration and intensity.
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Specify goals for therapy and any specific concerns.
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Review and sign any consent or disclaimer forms.
08
Submit the completed form to the appropriate healthcare provider.

Who needs physical formrapy wellness?

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Individuals recovering from injuries or surgeries.
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People with chronic pain or mobility issues.
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Individuals with conditions like arthritis, neurological disorders, or postural issues.
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Older adults seeking to enhance physical well-being and maintain independence.
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Physical formrapy wellness refers to a holistic approach that combines physical therapy techniques and wellness practices to improve overall health, alleviate pain, and enhance mobility.
Individuals engaging in physical therapy services, healthcare professionals providing therapy, or facilities offering wellness treatments may be required to file physical formrapy wellness documentation.
To fill out physical formrapy wellness, one should complete the required personal information, describe the condition being treated, list previous medical history, and provide consent for treatment.
The purpose of physical formrapy wellness is to promote physical health, prevent injury, facilitate recovery from physical conditions, and enhance the quality of life for individuals.
The information that must be reported includes patient demographic data, medical history, current health status, treatment goals, and any consent forms for the treatment being provided.
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