Please download and complete the appropriate forms from below and bring them with you on your first visit so we can assist you more efficiently. Forms can also be emailed back to us at office@choiceptcorning.com.

All patients must complete the 2 forms under the first menu. We ask that you then complete one form for the body area that you are seeking care for. We look forward to working with you! 

Forms all patients must complete

File

Medical History Patient Information

Download intake information forms

Form for upper extremity patients (hand, wrist, elbow, shoulder)

File

Quick Disability of the Arm, Shoulder and Hand Questionnaire

Download Quick DASH

Form for lower extremity patients (hip, knee, ankle, foot)

File

Lower Extremity Functional Score

Download LEFS

Form for back patients

File

Modified Low Back Pain Disability Questionnaire

Download MLBODQ

Form for neck patients

File

Neck Disability Index

Download NDI

Form for balance patients

Other forms (use only if directed) 

File

Disability of the Arm, Shoulder and Hand Questionnaire

Download DASH
File

Upper Extremity Functional Index

Download UEFI
File

Full Oswestry back disability questionnaire

Download Oswestry
File

Rolland-Morris Questionnaire

Download Rolland Morris
File

Tinetti Balance Test - therapist use

Download Tinetti
File

Dynamic Gait Index - therapist use

Download DGI
Please be advised: completing these forms and bringing or emailing them to us will help make your first visit go more smoothly. In order to schedule that first visit, you must call us or request scheduling via email or a personal visit to our office.