Questionnaire

Steps to Follow

1. Complete a questionnaire (Approximately 30 minutes to complete)
   
   Include your full medical history, even if you feel it has no bearing on your current condition. Your history of lifetime healing events (infections, surgeries, traumas) helps us determine whether therapy may benefit you.
   
   Choose one of these options to complete your questionnaire:
   
   
   1. Complete your questionnaire online*
      *Adobe Reader 9 or higher is needed-download free update here
      **Your answers cannot be saved. Please leave the pdf window open if you need to return to the form at a later time to complete it.
   2. Print a copy and fill out by hand
   3. Request postal mail delivery by calling 352.336.1433 or emailing info@clearpassage.com


2. Submit your questionnaire
   
   
   1. Online - Fill out online questionnaire, and click 'Sumbit Info to Clear Passage' at the end of the questionnaire
   2. By Email - Fill out online questionnaire, print, scan to computer, and attach your scanned copy to an email at info@clearpassage.com
   3. By Fax - Fill out online questionnaire, print a copy and fax to us at: 352.336.9980
   4. By Postal Mail - Print form, fill out, and send a printed copy via mail to:
      
      Clear Passage Physical Therapy
      4421 NW 39th Ave, Suite 2-2
      Gainesville, FL 32606
      USA
      
      
   We will thoroughly review your completed questionnaire, noting areas of pain, lifetime traumas, surgeries, infections and inflammations. We will also review any specific questions and goals you may have.


3. Receive our response
   
   Approximately ten days after receiving your completed questionnaire, we will postal mail you a letter advising whether therapy appears appropriate for you along with our full Introduction Package if you have not yet received it.


4. Schedule your therapy.
   
   Once we determine therapy appears appropriate for you, you may call 352.336.1433 to schedule therapy services or a 30 minute telephone consultation (at no charge) to further discuss your case. The therapist can answer any questions you may have about treatment. Our intent is to help us both understand your case, what you should expect from therapy, and whether this therapy may benefit you.
   
   

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