Patient Forms

If you are a new patient of Wayne Physical Therapy & Spine Center, you may be interested in printing out our patient forms to bring with you on your first visit. This will save you the time of having to do it at our office.

We ask that all patients fill out our patient form packet, which contains our Patient Information Form, our Medical History Form and our Authorization For Treatment Form. For patients being treated for neck please fill out the Neck Disability Index Questionnaire. For patients being treated for back pain, please also fill out our Oswestry Low Back Pain Disability Questionnaire. For patients with elbow or shoulder injuries please also fill out our Disabilities of the Arm, Shoulder and Hand (DASH) form, for those with hand or wrist injuries please fill out our Patient Rated Wrist/Hand Evaluation (PRWHE) form and for those with lower extremity injuries, our Lower Extremity Functional Scale, (LEFS). If you decide to fill out these forms in advance, please let the person who sets up your first appointment know you will be bringing the completed forms with you on your first visit!

As patient satisfaction is our priority as you complete physical therapy at our facility we invite you to complete our patient satisfaction survey and mail, Fax or email it to us!