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FORMS

In order to expedite the time you have to wait to see a physical therapist, please fill out the appropriate form(s) and bring them with you on your first visit:

 


 

Balance/Gait, Dizziness, Neurological Forms Pain / Orthopedic Disorders
Patient Intake Information  PAIN Intake Information
Dizziness Handicap Inventory Back Pain Questionnaire
Activities Specific Balance Confidence Scale (ABC) Arm, Shoulder, Hand Questionnaire 
Parkinson's Disease Questionnaire   Neck Pain Questionnaire
  Leg and Foot Pain Questionnaire 



Complete Balance Solutions
Institute for Rehab.
24422 Avenida de la Carlota, Suite 190
Laguna Hills, CA. 92653
Phone: (949) 340 - 6927
Fax: (949) 215 - 7246
E-mail: completebalancesolutions@gmail.com