Patient Forms

Patient Forms

We have provided our patient forms online for you to download and complete before your first office visit.  This saves you the effort of filling out the forms after you get to the office.

Please click on the link below to download the forms and print them.  Please bring the completed forms with your insurance card and your physician referral to your first appointment.

Each form listed below is a Word (.docx) document. If you have Word 97-2003, click the ‘.doc version’ under each listing. This will open up in a Word 97-2003 version.

PATIENT FORMS FOR FIRST VISIT

PATIENT INTAKE FORMS
    .doc version

*If you have been treated at Sapphire PT within the past 12 months and the information we have on file is still current, we do not need to update the Patient Intake Forms, however please complete the Medical History forms.

 

FUNCTIONAL OUTCOME MEASURES USED BY OUR PHYSICAL THERAPISTS

FABQ
    .doc version

Foot and Ankle Disability
    .doc version

Foot Function
    .doc version

Knee Outsomce ADL Scale
    .doc version

Lower Extremity Functional Scale
    .doc version

Modified Low Back Pain Disability Questionnaire
    .doc version

Neck Disability
    .doc version

Patient Specific Functional Scale
    .doc version

Shoulder Pain and Disability Index (SPADI)
    .doc version

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