Chugach Physical Therapy
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        • Laura Croix
        • Rainy Diehl
        • Michelle Drake
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        • Karen Hansen
        • Dorothy Martin-Calkins
        • Linda Sheppard
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        • Lezlie Robinson
        • Jacquline Hartman
        • Jeri Henry
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        • Laura Croix
        • Linda Sheppard
        • Joan Stassel
        • Stacey Szymanski
        • James Werner Jr.
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        • Sammy Dee
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What is an evaluation?

An evaluation is a process in which the physical therapist makes clinical judgments based on data gathered during an examination. The examination includes taking a comprehensive history, performing a review of systems, and conducting tests and measures. Tests and measures may include but are not limited to tests of range of motion, motor, function, muscle performance, joint integrity, neuromuscular status, and review of orthotic/prosthetic devices. The physical therapist will evaluate the examination findings, establish a physical therapy diagnosis, determine the prognosis, and develop a plan of care that includes the anticipated goals and expected outcomes, interventions to be used, and anticipated discharge plans.

If a patient has been discharged from care for any reason or has not been treated within 30 days of the last treatment, a new evaluation will be performed should the patient return to the clinic.

A re-evaluation is a process in which the physical therapist re-examines the patient to evaluate progress and to modify or redirect intervention and/or revise goals and expected outcomes. Re-examination may be indicated more than once during a plan of care. Tests and measures include but are not limited to those performed in an evaluation. The physical therapist will modify/update the plan of care as is indicated and suppot medical necessity of skilled intervention.

What to bring

Printed and filled out forms (4)
  • Demographic Sheet
  • Cancellation and No-Show Policy
  • Consent for Treatment
  • Health Information Form
Photo ID
Referral from physician
Insurance card(s)

What to wear: comfortable clothes that allow acess to the body part being treated, tennis shoes

Evaluation Forms

Please print and complete these four forms to your evaluation:

Demographics

Demographics
File Size: 124 kb
File Type: pdf
Download File

Cancellation/No Show Policy

Cancellation/No Show Policy
File Size: 199 kb
File Type: pdf
Download File

Treatment Authorization

Treatment Authorization
File Size: 201 kb
File Type: pdf
Download File

Health Info

Health Info
File Size: 881 kb
File Type: pdf
Download File

For all evaluation forms, please click the button below.
Evaluation Forms
  • Home
  • About Us
    • Services
    • Contact Us
  • Our Team
    • Midtown Clinic >
      • Therapists >
        • Laura Croix
        • Rainy Diehl
        • Michelle Drake
        • Boyd Esplin
        • Karen Hansen
        • Dorothy Martin-Calkins
        • Linda Sheppard
      • Staff >
        • Lezlie Robinson
        • Jacquline Hartman
        • Jeri Henry
        • Savannah Green
        • Austin Anderson
        • Elizabeth Faaliga
    • South Anchorage Clinic >
      • Therapists >
        • Laura Croix
        • Linda Sheppard
        • Joan Stassel
        • Stacey Szymanski
        • James Werner Jr.
      • Staff >
        • Sammy Dee
  • Evaluation Forms
  • FAQ
    • Preferred Providers
    • Insurance & Billing
    • Evaluation Information >
      • Evaluation Forms
    • Products
  • Fitness Center
  • Blog