Client Forms

Client Forms

Download, print, fill-out and bring to your appointment.

In order to get you checked in quickly when you arrive, our forms are available here.

Please download and print the appropriate form below. Fill it out and bring it with you to your first visit.

If you have any questions, please contact us at 503-885-8677.

Health History Forms

• History Questionnaire
  This form is just for your first visit.
• Women’s Health Questionnaire
  This form is for women who need help with women’s issues.
• Pelvic Health Consent Form
  This form is for women.

Functional Scale

• Lower Extremity Functional Scale (LEFS)
  This form is people dealing with leg pain or problems.
• Oswestry Neck Pain
  This form is for people with neck pain.
• Oswestry Low Back Pain
  This form is people with pain in their lower back.
• Quick – Disability of the Arm, Shoulder, and Hand (Q-DASH)
  This form is for people with arm, shoulder, and hand problems.
• Pelvic Floor Distress Inventory (20)
  If you are experiencing urinary incontinence, rectal incontinence or pelvic organ prolapse.
• Vulvar Pain Questionnaire
  If you are experiencing genital pain.

Once downloaded, these forms should open easily on your computer.

If not, please download and install the free Acrobat Reader.