Get Physical Therapy Medical Screening - Agility Physical Therapy

Filling out the Physical Therapy Medical Screening form is an essential step in ensuring you receive appropriate care tailored to your needs. This guide will walk you through each section of the form, providing clear instructions to help you complete it accurately and confidently.

Follow the steps to fill out the Physical Therapy Medical Screening form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred digital format.
2. Begin by entering the date at the top of the form. This indicates when you are filling out the document.
3. Provide your full name in the designated field. Ensure that you use your legal name for accuracy.
4. Indicate your gender by selecting either M or F. If you prefer not to disclose, you may leave this blank.
5. Fill in your age, as this information is crucial for your medical assessment.
6. Answer the smoking question by selecting Y for yes or N for no.
7. Indicate if you are currently pregnant by selecting Y for yes or N for no.
8. In the occupation section, briefly describe your job or primary activity to provide context for your physical activity levels.
9. Describe your regular exercise routine in the allocated space to help the therapist understand your fitness background.
10. List any medications you are currently taking within the provided spaces. Include the dosage and how each is taken.
11. If you have had any surgeries, detail them along with the dates in the Past Surgical History section.
12. In the Past Medical History section, circle each condition that you have been told you have or have had, providing a comprehensive overview of your medical background.
13. If applicable, explain any recent illnesses in the provided space.
14. Answer the questions regarding blood thinners and latex allergies with Y for yes or N for no.
15. Circle any current symptoms you are experiencing in the provided list.
16. In the CURRENT SYMPTOMS section, specify where you are feeling pain and the approximate date your pain started.
17. Describe how your pain began and any treatments already received in the allotted sections.
18. Indicate whether you have had any imaging studies, and describe them in the space provided.
19. State your personal goal for therapy to guide your treatment.
20. On the pain scales provided, circle the number that best represents your average pain for the last 48 hours.
21. Using the Body Chart, fill in areas where you experience pain and use the symbols provided to describe the pain type.
22. Identify what makes your symptoms better, providing as much detail as possible.
23. Circle any activities listed that make your pain worse, and note any additional activities that exacerbate your condition.
24. List times of day when your symptoms are best and worst.
25. Identify up to three key activities that you struggle with due to your condition.
26. Once all sections are completed, review your entries for accuracy and clarity.
27. Save your changes, then download, print, or share the completed form as needed.

Complete your Physical Therapy Medical Screening online to initiate your care today.