2000 Bremo Road, Suite 202
Richmond, VA 23226
804-285-0148
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The Patient Registration Form is required for all new patients on their first visit to Orthopedic Physical Therapy, Inc. You may also find specific forms and questionnaires below that apply to your diagnosis or problem.
Please print and fill out the appropriate forms prior to your initial office visit.
- Patient Registration Form (required)
- Referring Event Form
- General Orthopedic History Form
- General TMJ History Form
- Female Pelvic Floor Intake Questionnaire
- Male Pelvic Floor Intake Questionnaire
- Male Chronic Prostatitis System Index
- Bowel Questionnaire
- Neck Disability Index Form
- Disabilities of the Arm, Shoulder, and Hand Questionnaire
- Lower Extremity Functional Scale Form
- Oswestry Back Pain Disability Questionnaire
Please call Orthopedic Physical Therapy, Inc. at (804) 285-0148 with any questions about the new patient registration form or our questionnaires.
Online Patient Resources
American Academy of Craniofacial Pain American Fibromyalgia Syndrome Association American Physical Therapy Association Arthritis Foundation Fibromyalgia Network Institute for the Study and Treatment of Pain International Myopain Society International Pelvic Pain Society Secret Suffering - a resource for chronic pelvic pain National Vulvodynia Association National Association for Continence TMD/TMJ (Temporomandibular Disorders) Virginia Physical Therapy Association
Radio Interview Excerpts:
Listen to Dr. Tracey Adler being interviewed by Gloria Taylor Edwards and Shirley T. Burke on the "Speaking from the Heart" Radio Show - WCLM Radio 1450AM. The topic of their discussion was "The Magic of Dry-Needling". Click on the links below to listen.
Resources for
Healthcare Professionals
...Judy Collins, NP
...Women's Healthcare at Stony Point
...Phone: 804-560-8950
...Judy Chin, MD - Radiation-Oncology
...Phone: 804-266-7762
...Tina Shiver, RD - Dietician
...Phone: 804-254-1002
...Pat Buxton - Alexander Practitioner
...Phone: 804-741-0164 or 804-288-1881
...Shepherds Center
...Phone: 804-355-7282
...LINC - LINC @ University of Richmond Law
...Phone: 800-469-6092
...Senior Navigator
...Phone: 804-827-1280
...Glenmore Yoga & Wellness Center
...Phone: 804-741-5267
Fax Number: (804) 673-6026
Email: care@orthopedicptinc.com
Pelvic Pain .. Myofascial & Referred Pain .. Men’s Health Issues .. TMJ / TMD .. Forms & Resources .. Meet the Therapists .. Insurance .. Contact Information
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