Skip to main content

TIMOTHY L. FAGERSON, DPT Doctor of Physical Therapy

SOS: Help for Spine, Orthopaedic & Sports Injuries
Timothy L. Fagerson, DPT
SOSPT Rx Philosophy
Forms
Directions
Payment Policy
Orthotics
Publications
Contact Us
Testimonials
Alter G
Restore, Maintain, Enhance 
 
 
SOS-PT Patient Forms

Below are the intake forms that you will need to fill out prior to your first visit.

Please bring these completed forms to your Initial Evaluation with Dr. Fagerson.

Alternatively, we can fax these to you or you can arrive 15 mins early to fill them out.


1. Personal Information Form

2. Heath Status Questionnaire

3. Pain Drawing Form

4. HIPAA Form

 

Condition Specific Scores: Dr. Fagerson may request that you complete one of the scores from this link: http://www.orthopaedicscore.com/