No two client situations are the same. A full and complete description of your current complaint and how you got here is extremely important to ensure that your treatment is safe and appropriate for you. Thank you for taking the time to follow the steps below and provide these details in advance of your initial appointment!

1. Electronically fill out, sign, and submit our client self-assessment & intake.
   • Upon submission, you should be redirected to this page. If you are unsure if your form was successfully submitted, please contact us to confirm by either sending a text with the green “Text” button at the bottom-right of this screen or calling us at (360) 752-2673.
   • If you would prefer to fill out your form by hand to bring with you to your first appointment, you may download and print it here.
   • You may also view and/or download our financial policies and HIPAA disclosure; or, if you prefer, paper copies are available upon check-in.
2. Select the Functional Outcome Reporting below for the area or condition to be treated. Once downloaded, please print it, fill out a hard copy, and bring it with you to your initial appointment. This allows your therapist to understand how your condition is affecting your daily activities. As you answer the questions, think about pain or discomfort when it is at its worst and only as connected to the condition to be treated. For example, if you are receiving treatment for an ankle strain but a chronic hip issue creates mobility issues, consider only the impact of your ankle in your response. If you aren’t sure how to answer a question feel free to discuss it with your therapist.
   • Upper extremity (eg, wrist, forearm, elbow, shoulder)
   • Hand
   • Cervical/thoracic (eg, neck, upper to mid back, ribs)
   • TMJ
   • Lumbar (eg, low back into hip, tailbone, sacroiliac joint)
   • Pelvic pain & continence
   • Lower extremity (eg, foot, ankle, calf, knee, thigh to hip)
   • Neuromuscular
   • Large print, all areas (complete only the pages specific to your area of treatment.)
3. If you have been in an automobile accident: Complete, sign and bring this PIP Waiver with you to your first appointment.
4. If Medicare is your primary insurance: We are required to verify a complete record of your current medications. If you do not already have a comprehensive list, you may wish to use the following form provided by AARP:
   • Medication Record (PDF)
   • Medication Record (MS WORD)
5. For our pelvic health & continence clients:
   • Daily Voiding Log with instructions for completing a record of bowel or bladder function.
   • Vulvar Pain Questionnaire