Get Wy Premier Bone & Joint Centers Physical Therapy New Patient Intake Form 2022-2025

Filling out the WY Premier Bone & Joint Centers Physical Therapy New Patient Intake Form online is a crucial step in starting your physical therapy journey. This guide will walk you through the entire process, ensuring that you provide all the necessary information accurately and efficiently.

Follow the steps to complete the intake form with ease.

1. Use the ‘Get Form’ button to obtain the intake form and open it in your preferred format.
2. Begin by entering your personal information in the designated fields, including your name, today's date, and date of birth.
3. Indicate whether you are currently receiving any home health services by checking 'Yes' or 'No' in the corresponding box.
4. Provide your contact information, including your home phone, cell phone, email address, and mailing address.
5. Fill in your height and weight accurately.
6. Answer the allergy and injury-related questions by checking 'Yes' or 'No' for adhesive and latex allergies, as well as whether your injury is work or auto-related.
7. If you are taking anticoagulants, specify the type in the field provided.
8. Indicate your exercise habits by checking 'Yes' or 'No,' and if applicable, specify the number of hours per week and activities.
9. Complete the section regarding your work activities, indicating the percentage of your work that involves sitting, standing, or manual labor.
10. Fill out the health questionnaire, addressing your chief complaint, date of onset, cause of pain, and related secondary complaints.
11. Assess your pain severity by circling the appropriate numbers from 0 to 10 for current, best, and worst pain levels.
12. Describe any sleep interruptions caused by pain and select the difficulty level.
13. State your goals for therapy in the provided space.
14. Check any relevant health conditions by indicating 'Yes' or 'No'.
15. List any major illnesses, injuries, or surgeries that are pertinent to your treatment.
16. Document any medications you have taken in the past week, including dosage, frequency, and reasons.
17. Describe any additional conditions or precautions with your allergies.
18. Complete the falls history section by answering questions about injuries and falls in the past year.
19. Finally, review your information for accuracy, and sign the form to affirm that the information provided is accurate to the best of your knowledge.
20. After completing all fields, you can save changes, download the form, print it, or share it as needed.

Start filling out your form online today to ensure a smooth entry into your physical therapy experience.