Physical Therapy Patient Forms - Columbia Gorge Physical Therapy

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

Receipt of Privacy Practices

Patient Health History

Policy & Patient Agreement Form

Depression Survey

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

Concussion/Headaches/
Vertigo

Dizziness Handicap Inventory

Foot/Ankle/Hip

Lower Extremity Functional Scale

Arm/Shoulder/Wrist

QuickDASH Survey

Low Back Pain

Oswestry Low Back Pain Survey

Neck Pain

Neck Disability Index