Intake Form

Please complete this initial Intake Form before your first appointment.

Head, Neck, Shoulder, Upper Trap Pain

If you have pain in the head, neck, shoulder blades, or upper trap region, please fill out the Neck Disability Index form.

Shoulder, Elbow, Wrist, Hand Pain

If you have pain in your shoulder, elbow, wrist, or hand, please fill out the QuickDASH form.

Low Back Pain

If you have low back pain, please fill out the Oswestry form and the FABQ form.

Hip, Knee Pain

If you have pain in your hip or knee, please fill out the LEFS form.

Foot, Ankle Pain

If you have pain in your foot or ankle, please fill out the FAAM. If your goal is to return to a sporting activity or you injured yourself while playing a sport, please fill out the FAAM-Sports instead.

Heel, Achilles Pain

If you have pain in the back of your heel or Achilles tendon, please fill out the VISA-A form and the FAAM form.

Injury with Blow to Head, Possible Concussion

If you have had an injury with a blow to the head and would like to be evaluated for a possible concussion, please fill out the Concussion-Specific Questions, Post Concussion Symptom Scale, and Neck Disability Index


If you have been experiencing dizziness and would like to be evaluated, please fill out the Dizziness Handicap Inventory form.