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Patient Info & Forms

Admission

  1. Medicare Questionnaire
  2. Acknowledgement and Release of Medical Information
  3. HIPPA Notice of Privacy Practice

Medical History

  1. Initial Questionnaire
  2. Medication Checklist
  3. Pain Diagram

Outcome Forms

  1. Neck Outcome Index
  2. SPADI - Shoulder
  3. DASH - Arm, Shoulder, Hand
  4. Back Outcome Index
  5. Lower Extremity Functional Scale

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Locations

Butler
(724) 287-4111

Homecare
(724) 337-0420

Kittanning
(724) 543-1627

Leechburg/Allengheny Twp
(724) 845-2048

Lower Burrell
(724) 335-5526

New Brighton
(724) 847-1200

New Kensington/Arnold
(724) 339-7725

Pittsburgh Mills
(724) 274-4333

Sarver
(724) 353-0005

Corporate Office
(724) 337-6522
(800) 291-5060 - Toll-Free