Paso Robles Physical Therapy
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Forms

Forms listed below are for Patient Intake specific to insurance provider. Please take a moment to fill out the appropriate form prior to your first Initial Examination. If you have any questions please email our office manager chelcy@pasoroblespt.com
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To download forms please double click appropriate form. If you have any trouble we will be more than happy to email them to you. Please email chelcy@pasoroblespt.com
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Thank you.

Patient Intake Forms
Please fill out both forms below

Patient Information Form
patient_information_form__6_.pdf
File Size: 869 kb
File Type: pdf
Download File

patient_information_form.docx
File Size: 409 kb
File Type: docx
Download File

Patient Medical History Form
patient_medical_history__4_.pdf
File Size: 122 kb
File Type: pdf
Download File

patient_medical_history__1_.docx
File Size: 360 kb
File Type: docx
Download File


Pediatric Intake 
pediatric_intake__patient_medical_history.pdf
File Size: 72 kb
File Type: pdf
Download File

Pelvic Floor Intake
pelvic_rehab_intake.pdf
File Size: 59 kb
File Type: pdf
Download File


Statement of office policies
Sign & Initial

statement_office_policies__3_.pdf
File Size: 78 kb
File Type: pdf
Download File

statement_office_policies__1_.docx
File Size: 11 kb
File Type: docx
Download File


Functional TEsts

Please fill out the appropriate form related to your reason for seeing us.
Arm, Shoulder, Hand 
quickdash-initial.pdf
File Size: 393 kb
File Type: pdf
Download File

Lower Extremities
lefs-initial.pdf
File Size: 388 kb
File Type: pdf
Download File

Neck
neck-initial.pdf
File Size: 331 kb
File Type: pdf
Download File

Back
oswestry-initial__1_.pdf
File Size: 563 kb
File Type: pdf
Download File

Balance 
abc.pdf
File Size: 362 kb
File Type: pdf
Download File

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Copyright © 2015
  • Home
  • About
    • Orthopedics
    • Pediatrics
    • Neurologic
    • Pelvic Floor
    • Meet Our Staff
    • Testimonials
  • For Patients
    • Insurance
    • Forms
    • Your First Visit
    • Patient Survey
  • Telehealth
  • PD FIT
  • For Physicians
    • Insurance
    • Referral Forms
  • Contact
  • Patient Portal