Aquatic Therapy Intake and Medical Clearance Form for Pool Based Rehabilitation
Aquatic Therapy Intake and Medical Clearance Form for Pool Based Rehabilitation
Intake for aquatic therapy and pool rehabilitation covering injury, swimming comfort, skin conditions, and medical clearance requirements.
Client name *
Your answer
Date of birth
Phone
Referring physician *
Your answer
Rehabilitation Goals
Primary condition being treated
Describe your goals for aquatic therapy
Your answer
+ 16 more questions
About this template
Intake for aquatic therapy and pool rehabilitation covering injury, swimming comfort, skin conditions, and medical clearance requirements.
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