Columbia Gorge Physical Therapy is a Member of the Gorge Owned Network

Columbia Gorge Physical Therapy

Columbia Gorge Physical Therapy and Sports Medicine

Physical Therapy Patient Forms

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Forms for All Physical Therapy Patients:

For your convenience, click on any of the buttons below to download the form which you can print off and submit at appointment time:

Patient Information Form
Patient Information Form
Receipt of Privacy Practices
Receipt of Privacy Practices
Patient Health History
Patient Health History
Policy & Patient Agreement Form
Policy & Patient Agreement Form
Depression Survey
Depression Survey

Depending on your issue, please choose one of the following:

** if more than one body part then choose the one that has been more bothersome. 

Concussion/Headaches/
Vertigo

Dizziness Handicap Inventory
Dizziness Handicap Inventory

Foot/Ankle/Hip

Lower Extremity Functional Scale
Lower Extremity Functional Scale

 

Arm/Shoulder/Wrist

QuickDASH Survey
QuickDASH Survey

 

Low Back Pain

Oswestry Low Back Pain Survey
Oswestry Low Back Pain Survey

Neck Pain

Neck Disability Index
Neck Disability Index