Evaluation Forms
Please print and complete all 4 forms and bring to the evaluation.
Demographics |
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Cancellation/No Show Policy |
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Treatment Authorization |
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Health Info |
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The following forms are specific to your diagnosis or reason for coming to physical therapy. You only need to complete the forms that apply to your diagnosis. For example, if you are coming in due to a knee replacement, you only need to fill out the KOOS, JR form. These diagnostic specific forms are in addition the 4 admission forms above required of all patients. If you have any questions about which forms you need to fill out, please don't hesitate to call us at (907) 743-3333. You are also always more than welcome to come to your appointment 20-30 minutes before your evaluation and fill the paperwork out in our office.
Upper Extremity Functional Scale (UEFS) |
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Neck Disability Index (NDI) |
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Oswestry Low Back Assessment (ODI) |
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Lower Extremity Functional Scale (LEFS) |
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HOOS, JR |
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KOOS, JR |
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Dizziness Handicap Inventory (DHI) |
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