Intake Form -Kabworld Physiotherapy Services
Please complete this intake for new patients prior to your visit. We will not be able to start your visit unless this form is completed
Are you a new or existing patient?
Injury description (brief summary)
Intermitent fever in the last 3 months
Bower or Bladder issues in the last 3months
Road traffic accident or were admitted in Emergency room in the last 3months
Fracture or been placed on any special medication in the last 3months
How has your activities of daily living been affected?
Kindly list all medications you are currently on
Please click to download and read our "consent to treat" policy and thereafter click an answer below if you agree or disagree to the policy written here:
please click to download and read our 'consent to treat' policy as as found in here
a copy of your responses will be emailed to the address you provided
A copy of your responses will be emailed to the address you provided.
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This form was created inside of kabworldphysiotherapy.com.