Get Physical Therapy Questionnaire

Completing the Physical Therapy Questionnaire is an essential step in assessing your health needs accurately. By providing detailed and precise information, you facilitate a more effective evaluation and treatment plan.

Follow the steps to fill out the form with ease.

1. Click ‘Get Form’ button to obtain the questionnaire and open it for editing.
2. Begin by entering your age in the designated field. Make sure to provide your current age for accurate assessment.
3. Indicate your gender by selecting the appropriate option. If applicable, specify if you are currently working by answering 'Yes' or 'No'.
4. Answer whether you have previously undergone physical therapy to give the therapist context on your treatment history.
5. Describe the location of your pain or problem clearly in the provided space to help identify the specific area needing attention.
6. Explain the cause of your pain or problem in the space provided. This information can assist in understanding your condition better.
7. Indicate approximately when your pain or problem started by filling in the date in the format of month/day/year.
8. Evaluate your condition and specify whether it is getting worse, better, or staying the same.
9. Answer if you have experienced this pain or problem before. Your response will help the therapist assess recurrence.
10. Specify if your pain is constant by answering 'Yes' or 'No' to provide clarity regarding the duration of your discomfort.
11. Assess your pain level in the past couple of days by circling one of the options from mild to severe on the provided scale.
12. If you are taking any medication for your pain, indicate 'Yes' and specify what medication you are taking and its effectiveness, if applicable.
13. State if any of your usual everyday activities are affected by your pain or problem. If they are, describe how in the space provided.
14. List all past surgeries with the corresponding dates. This information is crucial for your therapist to understand your medical history.
15. Document all medical conditions you have been told you have, as this will help inform your treatment options.
16. Enter your name, provide your signature, and date the document before submission.
17. After filling out the questionnaire, ensure you save your changes, and consider downloading or printing a copy for your records.

Take the next step in your health journey by filling out the Physical Therapy Questionnaire online today.