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Physical therapy evaluation form

Initial self evaluation form 2025

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The document is an initial self-evaluation form for patients seeking occupational hand therapy at LoHi Physical Therapy. It collects personal information, reasons for therapy, symptom descriptions, and treatment history to better understand the patient's condition and tailor their treatment plan.

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Click ‘Get Form’ to open the initial self evaluation form in the editor.
Begin by entering your name and the date at the top of the form. This helps personalize your evaluation.
In the section asking for your referral source, provide the name of the person or organization that referred you.
Clearly state your reason for seeking therapy in the designated field, ensuring you express any specific concerns.
Use the provided diagram to mark areas of discomfort. Label each area with descriptors like 'Severe' or 'Aching' as applicable.
List and rate each symptom on a scale from 0 to 10, where 0 indicates no pain and 10 represents extreme pain. Fill out all relevant fields.
Answer questions regarding when symptoms began, potential causes, and factors that worsen or ease your symptoms.
Complete additional sections about sleep patterns, previous treatments, medications, and personal goals for therapy.

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What is an example of a good self-evaluation?

Dependability and integrity self-evaluation examples I take pride in being honest and accountable, even in challenging situations, and colleagues know they can rely on me to make principled decisions. 2. I am dependable when it comes to meeting deadlines and delivering quality work.

How do you write a self-evaluation form?

8 Steps to Write a Self-assessment Take ample time to complete the evaluation. Use your own voice and words. Think about how you truly feel. Consider the feedback you have received. Know your worth. Reflect on your mistakes. Identify achievable goals and future projects you want to work on.

What is a sample sentence for self-evaluation?

In social psychology, self-assessment is the process of looking at oneself in order to assess aspects that are important to ones identity. It is one of the motives that drive self-evaluation, along with self-verification and self-enhancement.

How do you start a self-evaluation sentence example?

53 phrases for an effective self-assessment In the past [period length], I focused on [goal]. I adopted new techniques to achieve my goals, including [work habits that helped you meet your targets]. While I strove to [name goal] in this past employment period, I was not able to achieve it because [reason].

What not to say in a self-evaluation?

Here are some common mistakes to avoid. Downplaying Your Contributions. Ignoring Areas for Improvement. Not Providing Examples. Not Seeking Feedback. Comparing Yourself to Others. Not Proofreading.

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How do I write my own self-evaluation?

To begin a good self-evaluation, ask yourself the following questions: 1. How am I doing in comparison to expectations? 2. What are my areas for growth? 3. What qualities and capabilities can I use to make a bigger impact? 4. How should I alter my approach and behavior?