Get Medical Screening Questionnaire
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Medical Screening Questionnaire online
Filling out the Medical Screening Questionnaire online is a crucial step in ensuring you receive appropriate and effective physical therapy. This guide will walk you through each section of the form to help you provide the necessary information accurately and confidently.
Follow the steps to navigate and complete the questionnaire effectively.
- Click the ‘Get Form’ button to access the questionnaire and open it in the appropriate editor.
- Begin by entering your past surgical history, listing all surgeries and their dates in the provided fields.
- Indicate your gender by selecting 'M' or 'F', and provide your age in the designated area.
- Select whether you are a smoker by choosing 'Y' or 'N', and list all current medications you are taking.
- If you are pregnant, specify 'Y' or 'N' and indicate the trimester.
- Provide your occupation and select whether your condition is work-related or related to a motor vehicle accident.
- Describe your regular exercise routine in the space provided.
- Answer whether you have had any imaging studies done, such as x-rays or MRIs, by selecting 'Y' or 'N'.
- In the past medical history section, respond to each condition with 'Y' or 'N', ensuring you include all relevant information.
- Indicate whether you are currently experiencing any health changes or symptoms by answering 'Y' or 'N' for each item listed.
- For current symptoms, indicate where you are experiencing symptoms and when they began.
- Provide details on how your symptoms developed, their current status, and any treatment you have received.
- Assess your pain levels over the past 48 hours using the provided scale.
- Mark areas on your body where you feel pain and indicate any activities that worsen or relieve your symptoms.
- Finally, review all the information you've entered. At this point, you can save changes, download the completed form, print it out, or share it as needed.
Complete your Medical Screening Questionnaire online to ensure your therapy process is tailored to your needs.
According to the CDC, a biometric health screening is defined as "the measurement of physical characteristics such as height, weight, body mass index, blood pressure, blood cholesterol, blood glucose, and aerobic fitness tests that can be taken at the work site and used as part of a workplace health assessment to ...
Fill Medical Screening Questionnaire
The Medical Screening Questionnaire will include questions related to your personal and family medical history, drug allergies and more. Medical Screening. Questionnaire. Please complete pages 2 to 7 before your appointment. Where are you currently having symptoms? What date (approximately) did your present pain start? Do you have any of the following medical conditions? If you have any of the medical conditions, please provide other relevant details. We ask questions based around fitness, frailty, mental wellbeing, nutrition, lifestyle behaviours and chronic health conditions.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.