Treatment Status - Natalie Bonfigilio


CLIENT NAME:


DATE OF ACCIDENT: ______ /______ /______

DATE:


FILE NO.: ________

NAME, ADDRESS AND TELEPHONE NUMBER OF DOCTOR YOU ARE CURRENTLY TREATING WITH:

HOW OFTEN ARE YOU RECEIVING PHYSICAL THERAPY?

ARE YOU TREATING WITH ANY SPECIALIST?

IF SO, LIST NAME, ADDRESS AND TELEPHONE NUMBER OF SPECIALIST:

PRESENT COMPLAINTS:

DO YOU HAVE ANY TINGLING, NUMBNESS OR FALLING ASLEEP SENSATIONS IN YOUR ARMS OR LEGS?

ARE YOU SATISFIED WITH THE TREATMENT YOU ARE RECEIVING FROM YOUR DOCTOR?

HAVE YOU COMPLETED YOUR TREATMENT?

IF SO, WHEN WHERE YOU FORMALLY DISCHARGED?

DID YOU MISS TIME FROM WORK?

IF SO, LIST DATES YOU MISSED FROM WORK

Leave this empty:

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Document name: Treatment Status - Natalie Bonfigilio
lock iconUnique Document ID: da5b5fd5bc097b0ef70e9ca3cb76e8372743acbf
Timestamp Audit
May 20, 2020 7:23 pm GMTTreatment Status - Natalie Bonfigilio Uploaded by David Rosenbaum - test@rosenbaumfirm.com IP 68.80.162.82
May 21, 2020 12:05 am GMTNatalie Bonfigilio - nbonfiglio@rosenbaumfirm.com added by David Rosenbaum - test@rosenbaumfirm.com as a CC'd Recipient Ip: 68.80.162.82