Follow the steps to successfully complete your questionnaire.

1. Click the 'Get Form' button to access the Physical Therapy Medical Screening Questionnaire. This will enable you to open the form in your preferred online editor.
2. Begin by entering your contact information. Fill in your name, gender, age, occupation, and exercise routine. Additionally, provide your smoking status and whether you are currently pregnant, along with the corresponding dates.
3. In the past medical history section, carefully select the conditions you have been diagnosed with or have experienced. Ensure you include any other illnesses or injuries in the provided space.
4. Indicate if you take blood thinners and if you are allergic to latex. Answer the mental health screening questions about feelings of depression and disinterest over the past month.
5. List any past surgeries and current medications, if applicable. Mention whether you have undergone any imaging studies such as X-rays or MRIs.
6. Proceed to the current symptoms section, selecting any symptoms you may be experiencing. Mark the areas of pain on the body chart accordingly.
7. Provide details about the onset of your pain, how it has progressed, and any sleep difficulties you may have faced. Share your personal goals for therapy and any concerns regarding falls.
8. On the scales provided, indicate the severity of your pain and overall level of function. Include specifics on what alleviates or aggravates your symptoms, as well as the best and worst times of day for these symptoms.
9. Complete the new patient information section with your contact details and information about your emergency contact. Choose your preferred method for appointment reminders and provide any necessary information.
10. Lastly, review the medical release and consent, office policy, and consent for the use and disclosure of health information. After reading everything, read through the policies carefully and leave the signature field blank to sign in the clinic.
11. Once completed, save your changes, and consider downloading, printing, or sharing the form to ensure all your information is securely documented.

Complete your Physical Therapy Medical Screening Questionnaire online today for your path to recovery!