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Physical Therapy History Intake Form

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HISTORY


HISTORY

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What kind of tests have been done for your current problem? (check if applicable)
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What are your goals as a result of attending physical therapy? Please check appropriate box.
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By submitting your signature, the parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

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