Release & injury forms

Release & injury forms

The information we need to help you recover faster

From medical release forms to injury disability indexes, the following forms assist your physiotherapist in providing and coordinating the best treatment and care possible. Please find the form indicated by your physiotherapist or our administrative team from the list below, and complete it by clicking the adjacent link.

RELEASE OF INFORMATION CONSENT FORM

This form enables Craven SPORT services to share your personal health information with other healthcare providers, including family physicians and specialists. Please be sure to clearly indicate what information you would like released, and to whom. Please complete one form for each individual you wish to have your health information released to.

RELEASE OF HEALTH RECORDS CONSENT FORM

This form enables Craven SPORT services to share your personal health records with other healthcare providers, including family physicians and specialists. Please be sure to clearly indicate what information you would like released, and to whom. Please complete one form for each individual you wish to have your health record released to.

FUNCTIONAL DRY NEEDLING CONSENT FORM

This form enables your physiotherapist to perform dry needling as a treatment method during your appointment. You will be required to review and complete this form before your therapist may utilize this technique. 

NECK DISABILITY INDEX

Your physiotherapist may request that you complete this form in order to paint a more objective portrait of how neck pain impacts your daily life. This can also be an important tool in measuring change in symptoms over time.

LOWER EXTREMITY FUNCTIONAL SCALE

Your physiotherapist may request that you complete this form in order to paint a more objective portrait of how lower extremity pain impacts your daily life. This can also be an important tool in measuring change in symptoms over time.

Roland morris Questionnaire

Your physiotherapist may request that you complete this form in order to paint a more objective portrait of how back pain impacts your daily life. This can also be an important tool in measuring change in symptoms over time.

QUICK DASH QUESTIONNAIRE

Your physiotherapist may request that you complete this form in order to paint a more objective portrait of how arm, shoulder, and hand pain impacts your daily life. This can also be an important tool in measuring change in symptoms over time.