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info@rueandprimavera.com
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Physical Therapy
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Langley Hand Clinic
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Patient Forms
We would like to make your appointment as easy as possible. Please take your time filling out these forms. If you have questions in regards to which form to fill out please call us!
New Patient Intake Packets
Patient Intake Packet- Physical, Occupational & Hand Therapy
Patient Intake Packet- Pelvic Floor Physical Therapy (Females Only)
Patient Intake Packet- Pelvic Floor Physical Therapy (Males Only)
Patient Intake Packet- Lymphedema
Previous Patient Intake Update- OT/PT
Informed Consent Laser Therapy & Medical History
Consultation/Wellness Screen Form
Forms
Authorization Forms to Release Medical Records
Patient Request for Medical Records
Liability Waiver- Fitness Room
No Show/Cancellation Policy Form
COVID-19 Informed Consent & Wellness Screening
Notice of Privacy Practices
Physical Therapy Outcome Measure
Lower Extremity Function
Neck Disability Index
Modified Oswestry Disability Scale
Shoulder Pain & Disability Index
Dizziness Handicap Inventory
Occupational/Hand Therapy Outcome Measure
Quickdash
Pelvic Floor Outcome Measures
Pelvic Floor Distress
Pelvic Floor Impact Questionnaire- PFIQ
Initial Vulvar Pain Functional Questionnaire (V-Q)
Queensland Female Pelvic Floor Questionnaire
NIH- Chronic Prostatitis Symptom Index (Males Only)
O'Leary Sant
Lymphedema Outcome Measure
Lymphedema Life Impact Scale- LLIS
Employee Forms
Time Off Request
Late CX/No Show Submission
Questions? 360-279-8323
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