Get Patient Questionnaire Please Bring A Hard Copy Of This

Completing the Patient Questionnaire is an essential step in your physical therapy process. This guide provides clear and supportive instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete your patient questionnaire.

1. Click ‘Get Form’ button to access the patient questionnaire and open it for completion.
2. In the first section, enter your name, date, and age. These details help accurately identify your records for the appointment.
3. Describe the problem that brought you to physical therapy in detail. Make sure to explain how it affects your daily life.
4. Indicate when the problem started and how it began, as this information is crucial for understanding your condition.
5. In the drawing section, mark the area(s) of discomfort. This visual representation aids your therapist in diagnosing your issues.
6. If you have experienced this problem before, specify it and note any treatments you received previously.
7. Use the discomfort scale to rate your pain from 0 (no pain) to 10 (emergency). This helps convey the severity of your condition.
8. Circle all words that describe your pain from the options provided. This clarifies the nature of your symptoms.
9. List activities that worsen your symptoms, which assists your therapist in understanding triggers for your discomfort.
10. Document what alleviates your symptoms; this may include heat, ice, or medication, providing insight into your pain management.
11. Indicate when your pain is usually worse and answer whether it interrupts your sleep. This information can impact your treatment plan.
12. Record your occupation and whether you are able to continue working, which gives context to your physical therapy needs.
13. Describe the physical demands of your job. This helps to tailor your therapy to accommodate your work activities.
14. State whether you can engage in recreational activities and if not, provide details. This helps in understanding your overall quality of life.
15. Outline your goals and expectations for physical therapy, as this guides your therapist in developing a suitable treatment plan.
16. In the medical information section, list any tests you’ve undergone and their results, which may be pertinent to your therapy.
17. Record any surgeries you’ve had with their dates to give your therapist a complete medical history.
18. If you are currently taking medications, indicate yes or no and list the medications you are using, as this may impact your therapy.
19. Mention any significant health history that is relevant, ensuring your therapist has all necessary background information.
20. If applicable, answer any specific questions regarding pregnancy status. This information can be crucial for your physical therapy planning.
21. After completing the form, save any changes, then download, print, or share your questionnaire as needed. Be sure to bring a hard copy to your appointment.

Start filling out your Patient Questionnaire online today for a smoother appointment experience.