ARP PATIENT TREATMENT ALERT
 
Which Clinic Location:
Patient Name:
Doctors Name:
Therapist Name:
Area Worked On:
Hot Spots:
Treatment Session Number:
Treatment Session 1
Treatment Session 2
Treatment Session 3
Treatment Session 4
Treatment Session 5
Treatment Session 6
Treatment Session 7
Treatment Session 8
Treatment Session 9
Treatment Session 10
Treatment Date:
Level of Pain AFTER Treatment #1:
1 - Lowest 2 3 4 5 6 7 8 9 10 - Highest
Level of Pain NOW:
1 - Lowest 2 3 4 5 6 7 8 9 10 - Highest
Number of Repetitions at Full Speed in Force Absorption Test AFTER Treatment 5:
Number of Repetitions now:
Did they follow eating plan:
Yes No
Did they abstain from all exercise or extracurricular activity:
Yes No
Did they dream:
Yes No
What did they do after treatment:
What time did they go to bed:
How often have they had solid waste:
Email to respond to:
Last pad placement:
CABLE 1-BLACK:
CABLE 1-RED:
CABLE 2-BLACK:
CABLE 2-RED:
Notes:

 
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