Patient Forms

Prior to your first visit with us at our SD physical therapy clinic, please take a few moments to complete your initial paperwork. Doing so will help us expedite your care and will save you time during your first appointment. Simply click on the button below to download and print!

Our forms are PDF files. To download and print the forms, you’ll need the free Adobe Acrobat Reader program.

Medical Questionnaire

In order for you to truly benefit from your physical therapy in San Diego, it is important for us to first create a clinical profile for you. This will allow us to establish a safe and appropriate therapy program customized specifically for you. Your input is extremely important, so please fill out the following questionnaire as completely as possible.

Medical Questionair

* = required field.

Enter Your Contact Information











Present Symptoms




Motor Vehicle AccidentWork InjuryOtherNo Injury/Incident



NumbnessPins / NeedlesShooting Pain


YesNo



YesNo

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Contact Us

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