Daisey Physical Therapy and The Center for Human Performance

Cervical/Neck

Shoulders/Rotator Cuff

Knees/Patella

Hips

Elbow and Wrist

Ankle and Foot

IMPROVE YOUR FLEXIBILITY IN ONE AREA OF THE BODY

First Name:
Age:
Gender:

I need a BEGINNING stretching program (I am generally inflexbile and am unable and touch my fingertips to my toes).
I need an INTERMEDIATE stretching program (I used to be very flexible, but have lost a great deal due to inactivity).
I am ready for an ADVANCED stretching program (I stretch routinely and would like to update my program and enhance my flexibility beyond its current level).

For which area of the body are interested in building a specialized stretching program?

Check any of the areas in which you experience recurrent pain (mild to severe) or any area in which you have been diagnosed with an injury or medical condition:

Neck - muscle pain
Neck- disc problems or surgery
Middle Back
Lower Back - frequent strains
Lower Back - pain as a result of a disc herniation

Hip - general
Hip - arthritis and hip replacement
Knee - arthritis or meniscus
Knee - ACL
Knee - Pain associated with your kneecap (Patellofemoral)

Shoulder - general strains (i.e. tendonitis, bursitis)
Shoulder - rotator cuff surgery, instability or dislocation
Elbow
Wrist
Ankle/Foot

Home l About Us l PT Bio l Directions l Insurance l Contact Us

Copyright © 2006, Daisey Physical Therapy & Sports Medicine Inc. All rights reserved.
The information contained in this web site is not a substitute for in-person, hands-on medical advice
or treatment. Daisey Physical Therapy recommends you consult with your physician or health care professional.