Moving Further Call or text today to schedule your free screen! 423-534-4344 Take our assessment to speed up the process! Assessment Intake 2 Name * First Name Last Name Email * Age * Discuss the problem * Provide a short description of your injury? What type of injury/symptoms/ concerns? How and when did it occur? Pain level 1-10/10? List activities that increase symptoms? List activities that decrease symptoms? Describe your pain? Is your injury caused by: * Select one: Recent trauma i.e. fall, MVA gradual onset other- discuss below If other... please describe further: Medical history * Select all that apply: Recent or ongoing cancer Recent or ongoing infection Recent/ relevant surgery None of the above Additional Information: Thanks for your submission. If you have had a recent trauma such as a fall or an MVA, Further Physio recommends that you consult your primary care provider prior to beginning physical therapy. If you have cancer or infection or recent surgery, Further Physio also recommends that you consult your primary care provider prior to beginning physical therapy. If your PCP is aware of your intent to participate in physical therapy despite these contraindications it is recommended that you schedule an evaluation with a Further Physio Physical therapist prior to beginning our comprehensive rehab programs.
