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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 

Physical Therapy BPPV History form

Choose this form if you have been referred for BPPV

Physical Therapy Vestibular and Balance History Form

Choose this form if you have been referred for balance issues

Physical Therapy Covid Rehab

Choose this form if you have been referred for post-covid rehabilitation

 "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

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

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