• Patient Forms | Mission Viejo Parkinsons Disease, Pelvic Floor and Lymphedema Services

    Tel: 949-716-1800
    Fax: 949-716-1799

    Weinstein and Associates Physical Therapy

    Lake Forest, Mission Viejo, Laguna Niguel and Laguna Hills Physical Therapist

    Specialists providing treatment for Pelvic Dysfunction, Lymphedema and Post-operative Breast Rehabilitation, Back and Neck Pain, Balance Disorders, and General Orthopedics

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    Our Patient Forms: Please download these forms and bring them with you to your first appointment, along with a complete list of your medications, including dosage and frequency.

    • Patient registration
    • Patient consent form
    • Medical history
    • Cancellation policy

    Functional outcome questionnaires: Please choose the appropriate form

    • For patients with disorders of the low back: Revised Oswestry Disability Index for low back pain
    • For patients with disorders of the neck: Neck Index
    • For patients with disorders of the arm/shoulder (DASH)
    • For patients with disorders of the leg (LEFS)
    • For patients with generalized weakness (Optimal)
    • Foot and Ankle Ability Measure (FAAM)
    • Modified Oswestry Low Back Pain Disability Questionnaire
    • Optimal Instrument
    • Patient Rated Wrist Evaluation
    • Knee Outcome Survey Sports Activities Scale (SAS)
    • Pelvic Floor Impact Questionnaire – Short Form 7 – Female
    • Pelvic Floor Impact Questionnaire – Short Form 7 – Male
    • Lymphedema Questionnaire

    SiteMap

    • Home
    • About Me
    • Our Staff
    • Our Services
    • Gallery
    • Patient Forms
    • Insurance Accepted
    • Contact Us

    Our Location

    Contact Us

    24953 Paseo De Valencia Suite 8C
    Laguna Hills, CA 92653

    Main Phone: (949) 716-1800

    Email: dweinstein0@gmail.com


    American Physical Therapy Association




    All information provided is provided for information purposes only and does not constitute a legal contract between Weinstein and Associates Physical Therapy and any person or entity unless otherwise specified. Information is subject to change without prior notice.