Pinnacle Performance

  • About Us
    • Clinical Staff Bios
    • Support Staff
    • Insurance Information
    • Professional Organizations
    • Cancellation Policy
  • Our Facility
  • Services
    • Manual Physical Therapy
    • Myofascial Release
    • Intelligent Movement Individual Sessions
    • Intelligent Movement/Pilates Classes
      • CoreAlign
      • Functional Training
      • MS Specific
      • Sports-Specific Progressive Training Programs
  • Blog
  • Education
    • Upcoming Courses
    • Ongoing Research
    • Advanced Training Resources
  • Resources
    • New Client Forms
    • FAQs
    • Testimonials
    • Pinnacle Community Practitioners
    • Preferred Outside Services

directions email contact Pinnacle 4 Performance

Explore Resources

  • COVID-19 Class and Individual Movement Guidelines
  • COVID-19 Class and Individual Movement Guidelines
  • Covid-19 Guidelines at Pinnacle
  • FAQs
  • New Client Forms
  • Testimonials
  • Nearby Amenities
  • Pinnacle Community Practitioners
  • Preferred Outside Services

New Client Forms

Please complete the following forms prior to your physical therapy appointment (download pdf’s):

▼New Client Intake with Insurance Info 2018

▼ Current Medical History Form

▼ Current Policies & Procedures

Forms for patients according to diagnosis

If you are seeing the physical therapist for low back pain, please complete the following forms:

▼ Oswestry Disability

▼ Rowland Morris

 

If you are seeing the physical therapist for neck pain, please complete the following form:

▼ NDI (The Neck Disability Index)

 

If you are seeing the physical therapist for knee pain, please complete the following form:

▼ KOS (Knee Outcome Survey)

 

If you are seeing the physical therapist for shoulder, elbow, or wrist pain, please complete the following form:

▼ DASH (Disabilities of the Arm Shoulder or Hand)

 

If you are seeing the physical therapist for leg, ankle or foot pain, please complete the following form:

▼ LEFS (The Lower Extremity Functional Scale)

 

All Medicare Clients will need to fill out the following form as well:

▼ Optimal Baseline

 

 

Newsletter

Contact Us




    Our Location

    1515 South 1100 East in Salt Lake City, Utah 1515 South 1100 East
    in Salt Lake City, Utah

    Like, Tweet & Share

    Facebook Twitter Instagram ShareThis
     
    Tweet
    • Home/
    • About Us/
    • Services
    • Blog/
    • Training/
    • Resources

    • Sign Up for Class/
    • Search
     
     

    © Copyright 2022 Pinnacle Performance, All Rights Reserved | Terms of Use | Privacy Policy | Disclaimer

    Pinnacle is a Polestar® Education Training Facility
    GYROTONIC® & GYROKINESIS® are registered trademarks of Gyrotonic Sales Corp and are used with their permission.

    Pinnacle Performance II, Inc. BBB Business Review