University of Delaware
Physical Therapy Clinic
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Physical Therapy Clinic
  • Home
  • About
    • Location & Hours
    • Mission Statement
    • Meet the Staff
    • Research Opportunities
    • Patient Testimonials
    • Donate
  • New Patient
    • Make an Appointment
    • Forms
    • Location & Hours
    • Insurance
    • Research Opportunities
    • FAQs
  • Current Patient
    • Scheduling & Cancellation Policies
    • Patient Resources
    • Exercise Log
  • Health Care Professionals
    • Residency
    • Fellowship
    • Rehab Guidelines & Protocols
    • Seminars
    • Journal Clubs
  • Services
    • Sports and Orthopedic
    • Neurologic and Older Adults
    • Pediatric
    • Specialty Clinics
  • Observation Experiences
    • Volunteering
    • Physical Therapy Practicum (PHYT400)
    • Single Day Observations
Select Page

FORMS

New Patient:

  • New Patient Registration
  • UD Notice of Privacy Practices
  • UD Notice of Privacy Practices (Spanish)
  • Patient Rights & Responsibilities
  • Non-Discrimination Policy
  • Medicare Secondary Payer Questionnaire (MSPQ)

Current Patient (seen within the last 60 days)

  • Consent Returning Patient

Body Sheet Forms:

Choose the area your physical therapy appointment is concerning, click the “+” to expand the section, and fill out the forms in that section to bring to your appointment.

Achillles
  • Achilles Tendon – Total Rupture Score (ATRS)
  • Achillles Tendinopathy (VISA-A)
Balance
  • Activities-Specific Balance Confidence Scale (ABC Scale)
Concussion
  • Concussion Packet
Foot and Ankle
  • Foot and Ankle Ability Measurement
Hip
  • Hip Outcome Score (HOS)
Knee
  • Knee Survey (KOOS)
  • Knee Activities of Daily Living Scale (KOS ADL)
Low Back
  • Low Back Questionnaire
  • Spine Intake Questionnare
Neck or Cervical
  • Neck Disability Index
  • Spine Intake Questionnaire
Thoracic/Middle Back
  • Spine Intake Questionnaire
Shoulder, Arm, Hand
  • DASH Questionnaire
TMJ or Jaw
  • Jaw Function Limitation Scale
Vestibular
  • Dizziness Inventory
University of Delaware HEALTH

Legal Notices | Privacy Practices |
Non-Discrimination Policy

Hours
We are open convenient hours for appointments Monday through Friday 7:30 am to 6:30 pm. Please call 302-831-8893 to schedule an appointment.

Parking
Patient parking is available in two hour increments. Clear signs designate these spaces.

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