PATIENT  FORMS

At Physical Therapy Associates of Smithtown we pride ourselves on providing a unique treatment plan for each individual patient.  For your convienience, we have provided links to our office forms that must be filled out before your initial evaluation.

The Patient Health Questionnaire must be filled out by each patient.  In addition, please select the functional form that best fits the injury/bodypart causing your problem.

If you would rather fill out these forms in the office please be sure to arrive 10 minutes early to allow ample time for paperwork before your evaluation.

Fill out the Patient Health Questionnaire to help guide your therapist during your first visit at physical therapy.

Fill out the NECK index if your major complaint is pertaining to your neck.

Fill out the BACK index if your major complaint is pertaining to your lower back.

Fill out the LEFS index if your major complaint is pertaining to your leg, knee, ankle or foot.

Fill out the DASH index if your major complaint is pertaining to your shoulder, arm, elbow, wrist or hand.

Fill out the PSF-750 index if have Oxford or Empire Plan (NYSHIP) insurance plans.

Please complete the Patient Information and Patient Completes this Section on this form.

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Physical Therapy

Associates of Smithtown

100 Maple Avenue

Smithtown, NY 11787

© 2015 Physical Therapy Associates of Smithtown.