NEW PATIENT FORMS

Before your first appointment please take a minute to download, print and complete the New Patient paperwork with specified forms appropriate for your injury.  This will help us provide you with the best possible patient care. All forms are in PDF format and can be opened with Adobe Acrobat Reader.  At times you may be seen for multiple concerns.  Please pick the primary concern from the list below or call our office and we can help you decide which forms best fit your needs.

 

 

Ankle

History/Patient Registration

 

Lower Extremity Functional Scale
 

 

Back

History/Patient Registration

 

Low Back Questionnaire

 

Elbow, Wrist, Hand

History/Patient Registration

 

Quick DASH
 

 

Gait, Weakness, Balance

History/Patient Registration

 

Lower Extremity Functional Scale
 

 

Hip

History/Patient Registration

 

Lower Extremity Functional Scale

 

 

Knee

History/Patient Registration

 

Lower Extremity Functional Scale

 

Neck, Upper back, Headaches

History/Patient Registration

 

Neck Disability Scale

 

Shoulder

History/Patient Registration

 

Quick DASH

@ 2017 - Alpha and Omega Physical Therapy - All Rights Reserved

VISIT US 

Show Low Office

861 E Cooley, Ste B

Show Low, AZ 85901

Pinetop Office

1684 E White Mountain Blvd, Ste 6

Pinetop, AZ 85935

Call one number to schedule your
consultation at either office today!

Show Low & Pinetop Offices:

928.537.2678

CALL

Tel.  928.537-2678

Fax. 866-762-2534

Email: aopt@pt4u.org

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