Patient Forms

Patient History and Consent Form

In preparation for your first appointment with Red Canyon Physical Therapy, please print the Patient History and Consent form below. This editable PDF can be filled out digitally or by hand, but you are required to print and sign the form, and bring it to your first scheduled visit.

Download Patient History & Consent Form

Along with this form, you should also bring:

  • Your Physical Therapy prescription, if applicable
  • Your insurance card or case number
  • Any relevant diagnostic reports you may have (for example, X-ray or MRI) and a valid ID

Additional appointment preparation forms:

Neck Questionnaire

Back Questionnaire

Shoulder, Elbow, Wrist Questionnaire

Lower Body Questionnaire

Dizziness, Balance Questionnaire

RC Pelvic floor Questionnaire

RC Womens Health Pelvic Consent

Vulvar Pain Functional Questionnaire

Activities specific Balance Confidence (ABC) Scale

Modified Falls Efficacy Scale – MFES Initial

Pelvic floor PFDI-20