Forms You Will Need

*Please click on the name of the document to open and print

Patient History Form: ALL NEW PATIENTS please download, print and complete this form before your appointment.

Patient Information Sheet: ALL NEW PATIENTS please download, print and complete this form before your appointment.

Release for Minor’s Treatment: This form needs to be completed by the PARENT/LEGAL GUARDIAN OF A MINOR CHILD receiving physical therapy. The top of this form can be completed before the appointment and the bottom section is completed after a treatment plan has been discussed.

Worker’s Compensation Injury Questionnaire: NEW PATIENTS WITH A WORK-RELATED INJURY, please download, print and complete this form before your appointment.

Medicare Patient Questionnaire: NEW PATIENTS WITH MEDICARE COVERAGE, please download, print and complete this form before your appointment.

Disabilities of the Arm, Shoulder and Hand: PATIENTS WITH UPPER EXTREMITY DISORDERS (such as issues with your elbow, wrist, hand, neck, and upper back), please download, print and complete this form before your appointment. This form will be updated by our team as you progress through treatment.

Neck Disability Index: PATIENTS WITH NECK DISORDERS, please download, print and complete this form before your appointment. This form will be updated by our team as you progress through treatment.

Lower Extremity Function Scale: PATIENTS WITH BACK OR LOWER EXTREMITY DISORDERS (such as issues with your hip, knee, ankle, foot, and low back), please download, print and complete this form before your appointment. This form will be updated by our team as you progress through treatment.

David Gilboe & Associates
23161 Greater Mack Avenue
St. Clair Shores, MI 48080
Phone:  586.779.8892
Fax:  586.779.2869

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Office Hours:
Monday, Tuesday & Thursday:
7:00 a.m. - 8:00 p.m.
Wednesday & Friday:
7:00 a.m. - 3:00 p.m.,
By Appointment Only

David Gilboe & Associates

You Need Them. We Have Them.

Physical Therapists, Occupational Therapists, Certified Hand Therapists, Athletic Trainer, Doctor of Physical Therapy, Certified Strength & Conditioning Specialist

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