Patient Forms

Listed are documents to help you start your physical therapy journey here at Shull Physical Therapy Center!

 

New Patient Prescription Form

A Prescription form from Shull Physical Therapy for you to print out and present to your physician to tell them that you are requesting to receive physical therapy with Shull Physical Therapy Center.

New Patient Demographic Form

Our New Patient packet is for all new patients to print and fill out to bring along to their first appointment. This packet includes questions of basic demographic information and an activity level assessment to help the therapist understand your condition to create the best possible treatment plan for you!

Vestibular Questionnaire

A second part to our New Patient packet specified to those suffering from BPPV or balance issues. This questionnaire will ask when your symptoms started, what symptoms occurred, and more to help the therapist understand your condition to create the best possible treatment plan for you!

Lower Extremity Function Scale

If you are experiencing pain, have an injury, weakness, or loss of function with your hip, knee, ankle, and/or foot, complete this questionnaire.

Back Function Scale

If you are experiencing pain to the back and/or down the legs, have an injury, weakness, and/or loss of function from your back complete this questionnaire.

Neck Function Scale

If your are experiencing pain to the neck and/or down the back or arms, have an injury, weakness, and/or loss of function from your neck, complete this questionnaire.

Upper Extremity Function Scale

If you are experiencing pain, have an injury, weakness, and/or loss of function with your shoulder, elbow, wrist and/or hand, complete this questionnaire.

Modified Falls Efficacy Scale

If you feel you are a risk for falls, are unsteady, or have a history of falls, complete this questionnaire.




Office Location:
4646 Corona Dr.
Suite #130
Corpus Christi, TX 78411


Shull Physical Therapy