PARK SOUTH PHYSICAL THERAPY FORMS

ALL PATIENTS FILL OUT THESE THREE FORMS

PATIENT INTAKE FORM   adobe pdf

 

PATIENT HISTORY FORM   adobe pdf

 

CANCELLATION POLICY   Microsoft Word Document

 

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PLEASE SELECT FROM THE LIST BELOW THE FORM WHICH IS MOST APPLICABLE TO YOUR INJURY

Low Back Pain Disability Questionnaire  adobe pdf

 

Lower Extremity Function Scale   adobe pdf

 

Neck disability form   adobe pdf

 

Shoulder Pain and Disablility form   adobe pdf

 

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ALL PATIENTS PLEASE READ  SIGN FORM BELOW
IF YOU ARE COMING IN WITHOUT A PRESCRIPTION FROM YOUR DOCTOR

NOTICE OF ADVICE    Microsoft Word Document

 

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ALL PATIENTS PLEASE READ THE NOTICE OF PRIVACY FORM

 

NOTICE OF PRIVACY    Microsoft Word Document

 

 

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We are located at:

37 Union Square West, 3rd floor (between 16th and 17th streets New York, NY. 10003
phone: (212) 647-8130    fax: (212) 647-8648