Please fill out all forms in BLACK ink.
Minor Patient Waiver – For patients who are under 18 years of age.
Functional Assessment Tools. Please choose and complete the form which is most appropriate for your current condition.
Back Index – For low back, lumbar patients.
Neck Index – For neck / cervical patients.
Disabilities of the Arm, Shoulder and Hand (DASH) – For shoulder, elbow, wrist, and hand patients.
Lower Extremity Functional Scale (LEFS) – For hip, knee, ankle and foot patients.