Physiotherapy intake
Maps where it hurts, for how long and what the person wants to get back to, so the first session starts with a plan.
About 4 min to complete. physiotherapy, pain, rehab.
Use this templateQuestions in this template
- Your name
- Where do you feel pain or stiffness?
- How did it start?
- How long has it been bothering you?
- Pain on a normal day
- Does the pain wake you at night?
- Have you noticed any of these?
- What is the one thing you would like to do again?
- Have you been referred by a doctor?
Related templates
Tell us what hurts and what you want back.
This helps your physiotherapist plan your first session. It is not a substitute for an assessment.