MPT Photo Upload Form
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Please Select Your Referring Meridian Physiotherapist
Please list your chief complaint and any changes you have experienced since you began this or any other treatment. Has the problem got better or worse or changed?
What are you doing for the chief complaint? And how often are you doing it? Ie. MPT exercises daily, following or not following diet and herb recommendations.
Are you taking any new medications or having any new problems?
Do you have any of the following? If so, please list and let your Primary Care Physician know.
If you checked any of the above, please describe.
Meridian Category 1- Please select all of the following that apply.
Meridian Category 2- Please select all of the following that apply.
Meridian Category 3- Please select all of the following that apply.
Meridian Category 4- Please select all of the following that apply.
Meridian Category 5- Please select all of the following that apply.
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