Dreher Physical Therapy

Orthopedics, Geriatrics, Neurology and Rheumatology

www.timdreherpt.com

Pain/Quality of symptoms (check all that apply):

What is your pain level from 0-10 (0=none, 10=severe)?

Pain Level at your Best
Pain Level at your Worst
Pain Level Usually

Please bring in the reports from your tests.

GOALS:

REVIEW OF SYSTEMS:  please check all of conditions that you have had or are currently experiencing.

Musculoskeletal:
Cardiovascular:
Sensory:
Neurological:
Respiratory:
Endocrine

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