Patient History Forms

Please select the appropriate form below, fill it out, and bring it with you to your first appointment. If you are unsure which form to select please select the first form labeled "Physical Therapy History Form."

Physical Therapy History Form

Choose this form for all orthopedic injuries, sports injuries, post surgical rehab, and balance.

Physical Therapy Concussion History Form

Choose this form for all concussion related injuries

Occupational Therapy History Form

Choose this form for all Occupational Therapy referrals 

Speech Therapy History Form

Choose this form for all speech therapy referrals

Speech Therapy History Children Form

Choose this form for all children speech therapy referrals

 "The physical therapy profession will transform society by optimizing movement for all people of all ages to improve human experience."

- American Physical Therapy Association Vision Statement

3150 N. 12th Street Grand Junction CO 81506 * ptscgj.com * Tel: 970-241-5856 * Fax: 970-241-8599

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