The Patient Registration Form is required for all new patients on their first visit to Orthopedic Physical Therapy, Inc.
You may also find specific forms and questionnaires below that apply to your diagnosis or problem. Please print and fill out the appropriate forms prior to your initial office visit.
- Patient Registration Form (required)
- Patient Attestation Form (Direct Access)
- Medical Services Agreement
- Activities-Specific Balance Confidence (ABC) Scale
- CSI Inventory Worksheet
- Custom Orthotics Policy
- Disabilities of the Arm, Shoulder, and Hand Questionnaire
- Dry Needling Consent Form
- Fear Avoidance Beliefs Questionnaire
- General Orthopedic History Form
- General TMJ History Form
- Lower Extremity Functional Scale Form
- Medicare Patient Information
- Neck Disability Index Form
- NFRS Pain Scale
- Oswestry Back Pain Disability Questionnaire
- Referring Event Form
- Scoliosis New Patient Packet
- TMD Pain Questionnaire
- Vestibular Intake Form
Please call Orthopedic Physical Therapy, Inc. at (804) 285-0148 with any questions about the new patient registration form or our questionnaires.
Online Patient Resources
Article Archives:
‘Time to Treat Men Right‘ – An article about Pelvic Dysfunction by ADVANCE for Physical Therapy and Rehab Medicine
Read the Washington Post’s new article, ‘Myofascial Pain Syndrome often leaves doctors baffled and patients untreated‘
Radio Interview Excerpts:
Click Here to Listen to Dr. Adler’s latest interview on Empire Radio Now (March 15, 2017)
Listen to Dr. Tracey Adler on the The Professionals Round Table with Michael David on Empire Radio Now
Dr. Adler is interviewed by Gloria Taylor Edwards and Shirley T. Burke on the “Speaking from the Heart” Radio Show – WCLM Radio 1450AM. The topic of their discussion was “The Magic of Dry-Needling“. Click on the links below to listen.
Radio Show, Part 1, Radio Show, Part 2