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 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
Men’s Health Questionnaire
This form is for men who need help with men’s issues
Pelvic Health Consent Form
This form is for both men and women
What Software Do I Use to Open the Forms?
Once downloaded, these forms should open easily on your computer already. If not, please download and install the free Acrobat Reader onto your computer.
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
What Software Do I Use to Open the Forms?
Once downloaded, these forms should open easily on your computer already. If not, please download and install the free Acrobat Reader onto your computer.
Don't Be Shy. Our Hands-On Therapists Specialize in Healing Touch.
Rather than hook you to a machine and leave you for the duration of your appointment, you’ll experience a significantly different, and caring approach here. Our clients rave about it.