Intake Form

» Intake Form

FYZICAL Granger, IN looks forward to having you join our host of satisfied clients. Without you there can be no triumph. Because physical therapy without the client is intent without involvement. However inspired, it is like rain without water, only a hope. Because you Love Your Life, your independence, your day… we exist.

We look forward to welcoming you to our state-of-the-art facility and providing you the best physical therapy in Granger, IN. To schedule an appointment, please call us at (574) 271-8424.

The below forms will be utilized during registration. The forms applicable to you, will be determined by your diagnosis and current complaints. To determine which forms you will need to complete, please contact our office at (574) 271-8424. These forms can also be texted or emailed to you by FYZICAL | Granger's administrative team. 


New Patient Intake Forms:

New Patient Intake Packet

Returning Patient Intake Forms:

Returning Patient Intake Packet

Balance Paperwork

Dizziness Handicap Inventory

ABC Scale

Dizziness Symptoms Scale

Concussion, Head Injury, and Cranial Pain

Sport Concussion Assessment

Migraine Disability Assessment

Headache Disability Index

TMD Index

Pelvic Health 

Overactive Bladder - OABSS

Pelvic Floor Distress Inventory


Chronic Prostatitis Symptom Index - Male

Leg Pain Paperwork

LEFS Form for Hip, Knee, Ankle, and Leg Pain

Foot and Ankle Disability Index

Oxford Hip Assessment

Tegner Lysholm Knee Assessment

Neck and Back Pain

Modified Oswestry Back Pain

Neck Disability Index

Arm and Shoulder Pain

Quick Dash Arm and Shoulder