Physical Therapy History Intake Form - Cone Health
P P Physical Therapy History Intake Form Referring MD: Family MD: HISTORY: 1. What is your reason for coming to therapy today? 2. When did your problem begin? 3. How did your problem start? 4. Please circle the appropriate answer: a) Do you have high blood pressure? Yes No ) D oyu crr e ntl h av i f ti ? ................
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