Get Physiotherapy Questionnaire

Completing the Physiotherapy Questionnaire online is an important step in receiving tailored physiotherapy services. This guide will help you navigate the form with ease, ensuring that you provide accurate and comprehensive information.

Follow the steps to effectively fill out the questionnaire.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Fill in the 'Patient Profile' section. Provide your first and last name, date of birth in DD/MM/YYYY format, and maiden name if applicable. Include your age, home address, and contact numbers for home and work.
3. Indicate your gender, select the appropriate occupation status, and provide any relevant emergency contact information, including relation and telephone number.
4. Specify the patient category from the options given, and provide the date of the event or consultation. Fill in information regarding your family doctor and referring doctor, including their names and any applicable file numbers.
5. In the 'How did you hear about us?' section, choose the appropriate options and provide names if prompted.
6. Complete the 'Health Questionnaire' section by detailing your reasons for consulting a physiotherapist, noting any consultations with doctors regarding your problem, and listing any investigations you have undergone.
7. List any medications you are currently taking along with the doses, and mention other treatments you are receiving for your condition, specifying the type of treatment and the professional’s name.
8. Check any related symptoms that apply to your condition from the provided list.
9. Review the 'Medical History' section and check all medical conditions you currently have or have had in the past, including general, digestive, cardiovascular, respiratory, genitourinary, and infectious conditions.
10. In the 'List accidents, injuries, surgeries, implants, recent hospitalization' section, provide detailed information about any relevant medical history.
11. Complete the 'Family medical history' section by listing hereditary diseases that may be present in your family.
12. Once you have filled in all the sections thoroughly, review the completed form for accuracy. Save changes, and you may also download, print, or share the form as needed.

Start filling out your physiotherapy questionnaire online today to ensure you receive the care you need.