Forms

Click here to download our registration paperwork for the first visit:

REGISTRATION FORMS

The following assessment forms are available as separate downloads. In addition to completing your registration forms,
please download and complete the appropriate form(s) for your conditions:

 

MODS (Modified Oswestry Disability Scale)
• Back pain (upper, middle and lower)

Neck Disability Index
• Neck pain

DHI (Dizziness Handicap Inventory)
• Dizziness
• Vertigo

QuickDASH (Disabilities of Arm, Shoulder and Hand)
• Shoulder pain
• Elbow/Forearm pain
• Wrist/Hand pain
• Finger pain

LEFS (Lower Extremity Functional Scale)
• Hip pain
• Thigh pain
• Knee pain
• Ankle/Foot pain

 

NOTE:  If you’re experiencing pain in multiple areas, complete all appropriate forms.  For example, someone with lower back pain and leg pain would complete both the MODS and LEFS forms.

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