Download Forms

This page contains links to downloadable patient information forms. Some of these forms are used to provide your physical therapist with the information needed to make a proper evaluation and develop an effective treatment plan; others are necessary for prompt insurance reimbursement filing.

Clinical Evaluation Forms

These questionnaires provide important diagnostic information. Please download, print, and complete the questionnaire that best corresponds to your pain or injury. If you aren’t sure which one is appropriate for you, please call the clinic at (408) 358-6505. We’ll be happy to assist you.

Oswestry Back Pain Questionnaire (.pdf)
Neck Disability Index (.pdf)
The Dash (.pdf)
Shoulder Questionnaire (.pdf)
Wrist-Hand FAQ (.pdf)
Hip Condition Questionnaire (.pdf)
Lysholm Knee (.pdf)
Foot Ankle Index (.pdf)

First Visit Forms

These forms are required for your first visit:

PatientInformation (.pdf)
ConsentForm (.pdf)
FinancialPolicy (.pdf)
Medical History (.pdf)

All Four First-Visit Forms (.zip)

Please bring your completed forms with you when you visit the clinic.