Fyzical Therapy Physical Therapy Cape May, NJ Cape May Court House, NJ Cape May County, NJ

Download and fill out this form if you are being seen for any problem dealing with your Hip(s), thigh, Legs, Ankles, Feet &/or Toes 

Rates the intensity of your dizziness

The Activities-specific Balance Confidence (ABC) Scale* . Determines your level of confidence in doing the activity without
‚Äčlosing your balance or becoming unsteady

Assess fear of falling

Download and fill out this form if you are being seen for any problem dealing with your Neck and/or if you have pain referred into your arm, hand and/or fingers

Helps you assess how safe your home is; weather you are at risk of falling due to your home environment.

Provides important imformation to help the Doctor detemine the nature of your Vestibular / Dizziness and/or Balance problems.

FORMS: 
You may download and fill out the needed forms prior to your visit or wait until your visit to fill them out.  (some Intake Forms may not be ready for download yet)

                  
 

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Assess frequence and severity of dizziness symptoms within the last 12 months

 Download and fill out this form / Currently unavailabe.

Download and fill out this form if you are being seen for any problem dealing with your Back and/or if you have sciatic type pain in your leg.

Forms related to Balance, Vertigo &/or Dizziness

Identifies difficulties that you may be experiencing because of your dizziness.

Questions to help you stay / maximize your independence

Download and fill out this form if you are being seen for any problem dealing with your shoulder, arm, wrist and/or hand. 

Parkinson's questionnaires