Physical Therapy Orders





Evaluate and Treat


TractionJoint MobilizationSoft Tissue MobilizationStretching


Passive ROMActive Assisted / Active ROMStrengtheningCore StabilizationProprioceptive Training


Moist Heat / IceUltrasoundElectrical StimulationIontophoresis




I certify that this patient is under my care and requires physical therapy treatment as prescribed above.




Printable form with fax instructions