Get Lohi Physical Therapy Initial Self Evaluation Form

Completing the LoHi Physical Therapy Initial Self Evaluation Form online is a crucial step in receiving personalized care. This guide will help you navigate each section of the form, ensuring you provide all necessary information for effective treatment.

Follow the steps to fill out the form efficiently.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by filling in your name and the date at the top of the form. This information helps to identify your documentation.
3. Indicate who referred you to the physical therapy services. This could be a healthcare provider, family member, or friend.
4. Next, describe your reason for seeking therapy in the provided section.
5. Utilize the designated area to mark or shade where you are experiencing discomfort. Use the provided descriptors to label these areas.
6. List and rate each symptom you have been experiencing. For each item labeled a, b, c, and d, write your symptom and rate the pain on a scale from 0 to 10.
7. Document when your symptoms began in the appropriate field.
8. Explain what you believe may be causing your symptoms.
9. Next, specify what activities exacerbate your symptoms. You can check multiple options including sitting, standing, or lifting.
10. Indicate what alleviates your symptoms.
11. Describe the daily pattern of your symptoms, including variations throughout the day.
12. Mention whether your sleep pattern is disturbed and indicate the typical number of hours you sleep per night.
13. If you have seen a physician, note any diagnoses you received.
14. List any diagnostic tests you have undergone, along with the results.
15. Provide information about any previous treatments you have tried for the condition and their outcomes.
16. List any medications you are currently taking.
17. Write down your occupation and detail how your condition affects your work.
18. Share the recreational or leisure activities you enjoy and indicate if these are impacted by your condition.
19. Detail your types and amounts of routine exercise.
20. Articulate your treatment goals in the corresponding section.
21. Lastly, indicate how much time you are willing to commit to improvement and add any other comments in the designated area.
22. Once completed, ensure to save your changes. You can then download, print, or share the completed form as needed.

Start filling out your form online today to take the first step towards better health.