FORMS

Physical Therapy Treatment Forms

For your convenience, the following WWS Physical Therapy and Vestibular Rehabilitation Treatment Forms are provided in PDF fillable format that can be downloaded, filled out, and printed. But if preferred, the forms may also be downloaded, printed, and filled out at home (Click to DOWNLOAD the forms):

Orthopedic Forms

• Elbow Injury & Treatment:

Medical History Form

QuickDASH Form

• Foot and Ankle Treatment:

Medical History Form

Lower Extremity Functional Scale (LEFS)

• Knee Injury & Treatment:

Medical History Form

Knee Outcome Survey (KOS)

• Low Back Pain:

Medical History Form

Modified Oswestry Low Back Pain, LBP, Questionnaire (ODI)

• Neck Injury Treatment:

Medical History Form

Neck Disability Index (NDI)

• Shoulder Injury & Treatment:

Medical History Form

QuickDASH Form

• Hip Injury Treatment:

Medical History Form

Lower Extremity Functional Scale (LEFS)

Vestibular Rehabilitation Forms

• Vestibular

Dizzy Medical History

Dizziness Questionnaire (DHI)

Youth Dizziness Questionnaire (Youth DHI)

• Gait Dysfunction

Dizzy Medical History

ABC Scale

Concussion Forms

• Adult Concussion Forms:

Adult Concussion Medical History Form

Dizziness Questionnaire (DHI)

Rivermead Questionnaire

• Youth Concussion Forms:

Youth Concussion Medical History Form

Youth Dizziness Questionnaire

Rivermead Questionnaire

Parkinson’s Disease Forms

• Parkinson’s Disease Forms:

Dizzy Medical History

Freezing of Gait (FGQ)

Modified Falls Efficacy Scale (MFQ)

Vestibular Therapy:

I was very pleased with the Vestibular Therapy that I received. I went from being dizzy to moving with ease in two visits. The entire staff At Wendy Webb Shoenewald Physical Therapy was very helpful and kind. Thank you!

CS.

BPPV:

Wendy,

I needed to come in for rehab for BPPV for the second time in as many years. It is a pretty disconcerting thing to have to deal with but I have had great care both times. Most recently with Jenna who, in addition to being quite knowledgeable in understanding the nuances of this condition and the treatment of it, had excellent “bedside manner” in keeping me calm and informed about what she was doing with each procedure. I had to come in three times dealing with this episode and feel very relieved and confident moving forward with my life.

Thanks so much.
MS

PT Treatment:

When I came to WWSPT I had difficulty walking, balance problems, a great deal of pain and very little hope. I was told I could be helped. Wendy had a plan, some things made no sense to me and were painful. Wendy encouraged me to work through the discomfort and soon I was doing better. Everyone in this practice is so pleasant and helpful providing a positive atmosphere for all their patients! I would recommend this practice to others.

D.L

PT Treatment:

Specific, tailored physical therapy is a key intervention to slow the progress of Parkinson’s Disease. Kelsey and Hannah are very experienced in this area and have been wonderful to work with. In particular, Hannah’s group PD classes are motivating and full of camaraderie.

JH.

PT Treatment:

All of the staff including the office are very knowledgeable and friendly. I would highly recommend Wendy Webb Schoenewald Physical Therapy. Kelsey was always on time to see me and willing to accommodate my time needs-even on a short notice. I cannot praise this dynamic team and their entire practice enough.

Best Regards,
NM

Parkinson’s Disease:

I want to write today to tell what a positive experience I had at WWS PT. The staff is very supportive, friendly and knowledgeable. The staff answering the phone gave all the necessary information needed and had other staff members answer other questions as well. Kelsey, the PT therapist, was excellent and supportive. She made things challenging but fun and provided information as requested by me. Other staff members (Hannah and Anne) were available to assist me and give me more information for continue support. WWS PT is a great group to work with. Thank you for all your help.

Knee Injury & Joint Rehab:

Words cannot adequately express my gratitude and appreciation for helping me walk pain free and regain the range of motion in my knee. Four years after knee replacement surgery I began experiencing pain in the knee joint and soon discovered I had lost 20+ degrees in my range of motion. The structural integrity of the knee was confirmed and PT was offered but there was not much hope for improvement. Wendy immediately assessed what she felt caused the pain and issues with my range of motion. Over successive weeks new and more intense exercises were introduced. The information she relayed regarding how muscles in one area affect other joints was extremely crucial to understanding my problem and ensuring a positive recovery. Self-awareness is critical to success. The entire staff is helpful, friendly and professional. To say that Wendy is an exceptional physical therapist is only part of the picture. She goes above and beyond the norm, helping make mobility a reality by imparting to her clients both the tools and the confidence to achieve their goal.

Thanks for the mobility,
P B-D

Sports Injury & PT Treatment:

WWSPT has the best possible environment for recovery. This staff is full of the most positive and encouraging people I have ever met. They are the reason that I was able to get back on the soccer field as quickly as I did. It was the most beneficial experience I could have had thanks to Kelsey challenging me each day. I have so much respect for the staff at WWSPT and would recommend them in a heart beat.

PT Treatment:

Ralph was extremely pleased with the rehab treatment at WWSPT. Anne was so good at explaining everything to us. She was also patient and kind. I feel that Ralph has made progress and is more confident now. (He also liked the PT who worked with him when Anne was on vacation.) It has been a positive experience for us!

Thank you so much.
RL

Orthopedic Treatment:<

Kelsey did a great job helping me recover from lower back surgery (laminectomy). All of the exercises that she recommended were very effective. She was especially good at loosening up my lower back when I started therapy.

I have been to other facilities in the past and would recommend this one first.

PT Treatment:

The atmosphere at WWSPT is joyful and encouraging. Kelsey was my therapist — she is professional but also personable. I have and will continue to recommend WWS Physical Therapy & Vestibular Rehabilitation to anyone who needs therapy.

Vestibular Rehabilitation:

Viviann, my therapist at WWSPT, helped me make it through an incredible journey. After a serious head injury, with Viviann’s guidance as well as my relentless practicing at home, I was able to achieve my treatment goals. My progress happened one day and one exercise at a time. It is now 17 months after the accident and I am doing great! The facility, the staff, and the encouragement were first rate!

Many thanks!
B

Vestibular Rehabilitation:

I made amazing progress with my treatment in a short period of time.

Thank you Palak!
GG.

Orthopedic Treatment:

I am happy to write about my experiences at WWSPT, because I’ve seen a great deal of improvement. In the decades since my injury, I have been to many physical therapy centers but never had such significant and measurable improvement. Wendy and Viviann addressed my injury rehabilitation needs with specific targeted exercises and tools and gave me lots of individual attention.

Thank You!
JM

PT Treatment:

I have been treated at WWSPT on two separate occasions for periods of up to 8 weeks. On both occasions, physical therapy was required to treat a relatively rare disease-related condition.

The staff is great at WWSPT. Each person that takes your call or greets you upon arrival is warm and friendly and makes you feel comfortable and ‘at home’. Appointments are made easily and care is taken to accommodate the patient’s schedule as much as possible.

I have been fortunate to work with Anne Haneman, PT, both during my prior treatment as well as my current PT. Anne is a very smart, very knowledgeable, and very kind person. She continually does a great deal of research to learn more about my condition and find ways to provide me with effective treatment options to do both at their facility and to practice at home. She is great to work with which takes the stress out of the entire process. I love that she is genuinely happy to see my progress. She loves what she does and it shows.

Thank you.
M L
Buckingham, PA

Orthopedic Rehabilitation:

In 2013, I was in physical therapy with Viviann for 5 months, 3 times a week, and she was just fabulous. Tendons above my knee had ruptured; I was in a cast for 2 months. Once the cast came off, it turns out your knee no longer bends AT ALL. And Viviann’s task was to bend my knee a little bit at a time. She would bend it until it hurt, and then briefly push it just a bit further. She had a lot of experience with this, and I very much trusted her. She also was warm and had a sense of humor, and I really felt I lucked out with such a kind and knowledgeable therapist. We of course also had other exercises. And the whole place was nice – the day my knee finally bent enough to go all the way in a circle on the stationary bike, the room cheered.

Smiles,
CD

Orthopedic Rehabilitation:

Although my trials regarding my numerous surgical procedures MAY seem extreme to the point of being laughable, I have faced each of them with the confidence that in my wellness toolbox, I have one of the best rehabilitation practices in our area, to rely on to see the job through to a terrific result.

I have had the chance to work with nearly every member on staff, for detached biceps, rotator cuff repair(s), Labrum repair, total left hip replacement, and total left knee replacement, and most recently, a shoulder procedure to stabilize the right shoulder capsule.

In each case I have remained encouraged that because of the talent present, the procedure has been understood, the plan for rehabilitation was based on a calculated approach, and the emphasis on home exercise to compliment that which was done at WWS, all worked together to restore me, to which I could never possibly fully express my gratitude.

T H

Positional Vertigo Treatment:

I never realized how Positional Vertigo impacted my daily life until it was gone! Yes gone! For Almost 9 years I adjusted many daily activities to avoid the sensation. My ENT referred me to WWS Vestibular Rehabilitation. After a few painless head maneuvers I feel much clearer, sleep through the night, and look forward to starting a yoga class.

Thank You! Thank You!
KZ
Doylestown, PA

Concussion Treatment:

The team at WWS Physical Therapy, in particular Kelsey and Vivian, were fantastic. They treated both my 9 year old daughter for a severe concussion as well as myself for lower back and leg pain. Everyone was courteous, professional and extremely knowledgeable. We appreciate their attention to our individual needs through our PT programs and definitely recommend them to others who are in need of physical therapy.

Thank you,
KG

Orthopedic Rehabilitation:

I have enjoyed a long term relationship with Wendy Schoenewald and her team of professional physical therapists. WWSPT treatment center is a calm environment of recovery and healing … allowing patients to return to health, function and one’s best life.

I refer to Wendy as my HDPT (Humpty-Dumpty) because she has done the impossible and “put me back together” after several orthopedic mishaps. Most recently, WWS has developed a challenging gym rehab program to strengthen the torn meniscus in both my knees in an effort to delay or prevent knee replacement surgery. Hannah and Jamie have worked tirelessly with me and produced excellent results – – I am very optimistic! WWSPT is clearly the best Physical Therapy practice in the region.

Thank You!
L.H

Orthopedic Rehabilitation:

Excellent results in reducing shoulder pain and increasing range of motion.

WL.

Orthopedic Rehabilitation:

I have been to WWSPT on 3 occasions. Twice after injuries and once after surgery. Treatment has always been excellent and in a very friendly atmosphere.

Thank you,
C.A.
1/15/2015

Vestibular, Balance and Healthy Aging:

I learned a lot and got a lot better. It exceeded my expectations. I even looked forward to going so early. Standing O for Wendy and Palak!

Thanks!
JB

Orthopedic Rehabilitation:

The entire staff at WWSPT is friendly, helpful and professional. Palak Mulji is an exceptional therapist whom I would highly recommend.

Thank you.
MT

Orthopedic Rehabilitation:

We had a very positive experience at WWSPT.
Joanne was very thorough, knowledgeable, experienced and supportive. She and Nick (my 11 year old) worked very well together.

Thank you!
CA.

Orthopedic Rehabilitation:

I worked with several therapists at WWSPT and they were all interested, helpful and accommodating.

Thanks.
LS

We strive to provide an environment of recovery and healing for our clients, to allow them to advance their health and return to function, recreation or sports. It is our belief that Physical Therapy is the initial link in the healthcare system for Musculoskeletal and Balance related issues and we are the true experts on exercise. We look forward to a long term relationship with our patients and their families over their life span and hope to become their practitioner of choice for acute musculoskeletal issues, neuromuscular issues as well as reoccurring events limiting their Wellness. We want to be a part of our patients Healthy living and Healthy aging.

FORMS

Physical Therapy Treatment Forms

Orthopedic Forms

Vestibular Rehabilitation Forms

Concussion Forms

Parkinson’s Disease Forms

Our Mission at WWSPT

WWSPT Mission 2.0

Contact WWS Physical Therapy

Ask About WWSPT Professional Associations

Physical Therapy Treatment Forms

Orthopedic Forms

Vestibular Rehabilitation Forms

Concussion Forms

Parkinson’s Disease Forms

Our Mission at WWSPT

WWSPT Mission 2.0

Connect With WWSPT:

Contact WWS Physical Therapy

Ask About WWSPT Professional Associations