McNerney & Associates, P.A. Patient Forms Neck – Initial Visit LEFS – Initial Visit Herdman Dizziness Questionnaire Dizziness Handicap InventoryDash – Initial Visit POTSOswestry (Back) – Initial Visit Medication List Pelvic Floor Patient History Pelvic Floor Distress Questionnaire Helpful Forms New Patient Form Returning Patient Form View all forms For the following treatment areas, please fill out the corresponding forms: Neck: Neck Disability Index Mid and Low Back: Modified Oswestry Questionnaire Lower Extremity: LEFS Upper Extremity: DASH Vertigo: Dizziness Handicap Inventory, Herdman Dizziness Questionnaire POTS: NMH-POTS Functional Inventory Pelvic Floor Patient History Form, Pelvic Floor Distress Questionnaire
