Forms
Embedded Files
425-200-5330
Intake Form
Intake Form
Please complete this initial Intake Form before your first appointment.
Head, Neck, Shoulder, Upper Trap Pain
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
Shoulder, Elbow, Wrist, Hand Pain
If you have pain in your shoulder, elbow, wrist, or hand, please fill out the QuickDASH form.
Hip, Knee Pain
Hip, Knee Pain
If you have pain in your hip or knee, please fill out the LEFS form.
Foot, Ankle Pain
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.
Injury with Blow to Head, Possible Concussion
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
Dizziness
Dizziness
If you have been experiencing dizziness and would like to be evaluated, please fill out the Dizziness Handicap Inventory form.
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