FORMS

Each service that Body Structure Clinic offers requires a various forms to be completed before services are rendered. Body Structure Clinic wants to give you the best care that we can, filling out the designated forms below will allow us to determine what steps we need to take to make this possible. Please choose the designated form(s) below.

ALL PATIENTS

Please click the link below and complete the health history form. Please bring this health history with you to your first appointment along with your insurance cards, driver’s license, and prescription from physician. You may also bring any other relevant information regarding your treatment. Body Structure Clinic expects all new patients to arrive 20 minutes prior to appointment time. Physical Therapy Health History.

PHYSICAL THERAPY HEALTH HISTORY

MEASUREMENT TOOL

Patients please select the correct measurement tool for your physical therapy treatment. Please bring the relevant measurement tool to your first appointment.

Pain In Upper Body (patients who have symptoms involving: shoulder, arm, elbow, wrist, hand, and fingers)
Pain in Lower Body (patients who have symptoms involving: hip, leg, knee, ankle, foot, and toes)
Neck Pain (patients who have symptoms involving: neck, jaw, and headaches, vertigo, mid to upper back)
Balance and Fall Prevention (patients who have symptoms involving: gait and balance)
Back Pain (patients who have symptoms involving: lower back and core strengthening)