Lower Extremity

There are often a number of forms that you must fill out prior to arriving for the first time at any healthcare provider’s office. We know that your time is important to you so for your convenience we have provided those forms to you at our website. Please download and complete each of the relevant forms listed below to the best of your ability. Bring each form with you to your first visit and provide them to the receptionist when you sign in. Certain insurance companies may require that we provide you with some additional paperwork that is not provided below. That paperwork will be provided for you, if necessary, upon your arrival.

Lower Extremity

  • The Lower Extremity Functional Scale

    We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity. 0 being extreme difficulty or unable to perform activity to 4 being no difficulty. Today, do you, or would you have any difficult at all with:

Pin It on Pinterest