Remote Physical Therapy Assessment
Patient Information
Name
Date of Birth
Gender
Male
Female
Other
Contact
Assessment Date
Subjective History
Chief Complaint
Onset, Duration, & Description of Symptoms
Previous Treatment/Interventions
Relevant Medical History
Medications
Objective Assessment
Observation/Posture
Range of Motion
Strength
Functional Testing
Special Tests
Pain Assessment (location/intensity)
Assessment/Diagnosis
Clinical Impression
Plan
Treatment Plan & Recommendations