• Skip to main content
  • Skip to footer

F Squared Physical Therapy

One Patient One Hour

  • About
    • Therapists
      • Dr. Paul Ochoa
      • Dr. Monique Dupree
      • John Wilbert
    • Space
    • Services
    • FAQs
  • Portal
  • Services
    • In-Office Visits
    • Donation Based Visits
    • Tele-Therapy Visits
    • Strength Training
    • Pilates
  • Blog
  • COVID-19
  • BOOK AN APPOINTMENT

Outcome Forms

  • Choose your form:
    Functional outcome assessments are tools we can use to score how your injury or symptoms are affecting your life. Each form is specific to a general area and contains questions that may (or may not) apply to you. Your therapist will guide you to which form applies to you and let you know when to fill one out.
  • Neck Index

    This questionnaire will give your provider information about how your neck condition affects your everyday life. Please answer every section by marking the one statement that applies to you. If two or more statements in one section apply, please mark the one statement that most closely describes your problem.
  • Index Score = [Sum of all statements selected / (# of sections with a statement selected x 5)] x 100
  • Over the last 2 weeks, how often have you been bothered by the following problems?
  • Hidden
  • Back Index

    This questionnaire will give your provider information about how your back condition affects your everyday life. Please answer every section by marking the one statement that applies to you. If two or more statements in one section apply, please mark the one statement that most closely describes your problem.
  • Index Score = [Sum of all statements selected / (# of sections with a statement selected x 5)] x 100
  • Over the last 2 weeks, how often have you been bothered by the following problems?
  • Hidden
  • DASH

    Please rate your ability to do the following activities in the last week by checking the number beside the appropriate response.

  • Please rate the severity of the following 5 symptoms in the last week.
    (# 24 thru # 28 )
  • ( [(sum of n responses / n) - 1] x 25, where n is the number of completed responses.)
  • Over the last 2 weeks, how often have you been bothered by the following problems?
  • Hidden
  • LEFS

    We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.

    Today, do you or would you have any difficulty at all with:

  • SCORE: _____/ 80
  • Over the last 2 weeks, how often have you been bothered by the following problems?
  • Hidden

Footer

One Patient. One Therapist. One Hour.

VISIT US

19 West 21st Street, RM 901
New York, NY 10010

CONTACT US

T: 212-675-5650
F: 646-844-7634
E: frontdesk@f2pt.com