Patient Forms

Please download and complete these forms for your first visit.

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Functional Assessment Forms

Please fill out one of the following forms adjacent the body area for which you are seeking Physical Therapy Care:

Area of BodyForm NameDownload
Hip/Knee/Ankle/Foot

Lower Extremity Functional Scale (LEFS)

Download
Shoulder/Arm/Hand

Disability of the Arm, Shoulder and Hand (DASH)

Download
Back

Oswestry

Download
Neck

Neck Disability Index

Download
General/Balance/Other

Falls Efficacy Scale (FES)

Download

Contact Information

Maine Feldenkrais & Physical Therapy
34 Hennessey Ave.
Brunswick, Maine 04011
Phone/Fax
207.725.7578/207.725.7549
Email:
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Hours

Monday - Friday
8:00 am to 6:00 pm

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Insurance

We accept most insurances. Check with your insurance company to inquire if you need a referral from your physician.

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