Patient Forms

New Patients please download and fill out the New Patient Forms prior to your first appointment.  Be sure to bring along your health insurance ID card.

 

Click on  New Patient Forms                    Read our Notice of Privacy Practices

Also, please fill out one or more of the following questionnaires, depending on what type of problem you are having:

For mid to low back and hip: Back Index

 

For neck and upper back:  Neck Index

 

For hand, wrist, elbow or shoulder: DASH Arm Shoulder Hand   or   Upper Extremity Functional Scale

 

For foot/ankle, knee or hip:  Lower Extremity Functional Scale

 

For headaches:  Headache Disability Index

 

For dizziness/equilibrium problems:  Dizziness Handicap Index

 

To help you describe your symptoms, we have included a Self Questionnaire

 

You may want to fill out more than one form.  For example you m ay be having neck pain as well as shoulder/arm pain.  In that case you can fill out the Neck Index and the Quick DASH.  We use these questionnaires to help us to ascertain your needs, and to help gauge your progress during your treatment.  You will have ample time during your evaluation and treatment sessions for questions and clarifications.

 

Your feedback is valuable!

Read what clients have to say about our services.  Let us know your experience at LoHi PT!   Amanda is great! My dizziness is gone and my neck...