New Patient Forms

MEDICAL  HISTORY  FORM

Complete the form online, then print it out:         ENGLISH        SPANISH / ESPAÑOL

Print the form out first, then write in your answers:      ENGLISH         SPANISH / ESPAÑOL



Some patients may need to fill out a functional score form

FUNCTIONAL  SCORE  FORMS

DASH:                            ENGLISH                         SPANISH / ESPAÑOL

QUICK DASH:                   ENGLISH                        SPANISH / ESPAÑOL

PATIENT SPECIFIC FUNCTIONAL SCALE (PSFS):       ENGLISH


Don't forget to print out the Medical History Form

DISCRIMINATION IS AGAINST THE LAW

Hand Center of Oregon, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Hand Center of Oregon, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Click HERE for more information.

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