If you’d like to get a head-start on the forms you’ll need to fill out, here they are as fillable PDFs.

To fill these out and email them back, please download the forms, add your information, and make sure to “Save As” a new document name with your name so we can keep track of your files! Once downloaded, please email them to us at contact@simonsphysicaltherapy.com.

• EVERYONE FILLS OUT THE FOLLOWING FORMS

  • Patient Email Agreement

  • Privacy Policy

  • Notice of Privacy Practices (nothing to sign, but important to look at)

  • Financial Agreement

  • Health History (2023)

• THESE FORMS ARE DIAGNOSIS-SPECIFIC. FILL THESE OUT IF WE RECOMMEND THEM TO YOU.

  • 1- Dizziness Handicap

  • 2 - FABQ

  • 3 - Facial Disability Index

  • 4 - Falls Efficacy

  • 5 - Foot Function Index

  • 6 - Headache Disability

  • 7 - Lower Extremity Functional Scale (LEFS)

  • 8 - Modified Falls Efficacy

  • 9 - Neck Disability

  • 10 - Oswestry Disability Scale

  • 11 - Pain Disability Index

  • 12 - Pelvic Floor Disability Index

  • 13 - Quick DASH