Physical Therapy Specialists, PC
3710 Gilbert St. Austin, TX 78703
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Medical History
PHYSICAL THERAPY SPECIALIST, PC
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Cancer
Diabetes
Chest Pain
High Blood Pressure
Stroke
High Cholesterol
Anemia or Blood Condition
Alcoholism
HIV / AIDS
Arthritis
Smoking
Hepatitis
Reflux
Skin Condition
Liver Disorder or Disease
Kidney or Bladder Disorder
Thyroid Disorder
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Eating Disorder (previous)
Eating Disorder (current)
Tuberculosis
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Obesity
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Reflux
Other Pulmonary Disorder:
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I have completed this questionnaire and have had any questions regarding its content answered fully. Due to the hands on nature of the treatment and Whe WUeaWing WheUaSiVW¶V safety, if information has been left out for confidentiality, please verbally communicate it to the therapist performing the evaluation.
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