Care Connections:

These questionnaires are specific to the condition for which you are being treated, and are valuable tools in development of your treatment plan and tracking your progress during treatment.  When completing your questionnaire, please keep the following in mind: 

1.  Answer every question, as closely as it applies to your situation.

2.  Choose only one answer in each section.  Even if more than one apply, choose the one that best fits your current status.

3.  When selecting your answer, answer only as it applies to the condition for which we are seeing you (i.e., If we are treating your knee, answer specifically for your knee, even if you also have injury to foot, hip, etc.)

4.  When completing the pain index, think of it as a scale of 1 to 10 question, and put a mark on the line as appropriate.

     (On a scale of 1 to 10: 1 being no pain at all, and 10 being unable to function AT ALL due to pain/need emergency care)



Low Back Questionnaire - click here to download and print.

Neck and Upper Back Questionnaire - click here to download and print.

Upper Extremity Questionnaire - click here to download and print.

Lower Extremity Questionnaire - click here to download and print.

Hand/Wrist Questionnaire - click here to download and print.

Multiple Area Questionnaire - click here to download and print.

TMJ Questionnaire - click here to download and print.

Neuromuscular Survey - click here to download and print.

Discharge Survey - click here to download and print.

​Free Screening Form - click here to download and print.


Accurate patient information is a vital part of your treatment here at Think Back Physical Therapy.  Below you will find several links to the paperwork that will need to be completed by you prior to beginning treatment in our office.  When you schedule your initial appointment with us, our Patient Care Coordinator will instruct you on which forms to print and bring to your initial appointment.  As a reminder, please arrive 15 minutes early for your initial appointment with us for paperwork review.  Please be sure to list all medications, prescription and over the counter, including dosage, frequency, and route (i.e.-oral, injectable, topical) on your medical history.  This information is vital.

Complete Patient Paperwork Packet:

Please click here to download and print the complete packet.  Be sure to complete all forms.  If the patient is a minor, a parent or guardian must sign paperwork authorizing treatment.