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New Patient Forms

Patient Forms

Patient History(78.33 KB)
Patient History Form (PDF)
Activities Discomfort Scale (PDF)(73.76 KB)
Activities Discomfort Scale (PDF)
Pain Drawing (Excel)(592 KB)
Patient History Review of Systems (Word format)(42 KB)
Patient History Review of Systems (Word format)
Patient Data Form (PDF)(76.07 KB)
Patient Data Form (PDF)
Patient History Review of Systems (PDF format)(77.42 KB)
Patient History Review of Systems (PDF format)
Patient Data Form (Word Format)(35 KB)
Patient Data Form (Word Format)
Activities Discomfort Scale (excel format)(24.5 KB)
Activities Discomfort Scale (excel format)
Pain Drawing(214.82 KB)
Pain Drawing

Exercise Forms

Cervical Spine Hand-Resistance Exercises(151.5 KB)
Cox® Cervical Spine Hand-Resistance Exercises
Cervical Spine Band-Unit Resistance Exercises (682.51 KB)
Cervical Spine Band-Unit Resistance Exercises
Proprioception Exercises(694.19 KB)
Proprioception Exercises with and without a stability ball
10 Basic Low Back Exercises(971.61 KB)
10 Basic Low Back Exercises - no equipment necessary
Low Back Pain Exercises with a Stability Ball (318.33 KB)
Low Back Pain Exercises with a Stability Ball
"This information and website content is not intended to diagnose, guarantee results, or recommend specific treatment or activity. It is designed to educate and inform only. Please consult your physician for a thorough examination leading to a diagnosis and well-planned treatment strategy. See more details on the DISCLAIMER page. Content is reviewed by Dr. James M. Cox I."