Forms

Help us get started...

Before you arrive for your first therapy visit, we collect information regarding your current injury and your medical history, so that we can better prepare for your treatments.

Please download and complete the forms below and bring them with you for your first appointment. If it’s easier, we will be happy to email them to you.

Patient Data Sheet

Medical History

Symmetry Notice of Privacy Practices

Symmetry PT Privacy Practices Information

Functional Surveys

Please complete the form most appropriate to your injury or condition.

Lower Back Functional Scale

Lower Extremity Functional Scale

Neck Functional Scale

Upper Extremity Functional Scale

Encuestas Funcionales

Por favor complete la forma más adecuada para su lesión o enfermedad.

Escala Funcional de la Espalda

Escala Funcional de la Extremidad Inferior

Escala Funcional de el Cuello

Escala Funcional de la Extremidad Superior

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