FISA TRATAMENT

NUME si PRENUME __________________________________________________________________

Data nasterii _____________________ Ocupatie ____________________________________

Telefon mobil ____________________E-mail ______________________________________________

Afectiunile cu care se prezinta / localizarea durerii sau restrictiei de miscare:

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Tratamente efectuate anterior pentru afectiunile prezente:______________________________________

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Istoric al operatiilor / accidentelor / bolilor:_________________________________________________

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Sporturi / hobiuri / alte activitati:__________________________________________________________

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Alte comentarii relevante:_________________________________________________________________

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Sedinta_____ / Data:_____________________

Evaluarea / progrese / schimbari observate: __________________________________________________

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Proceduri aplicate: _____________________________________________________________________

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Comentarii / observatii:___________________________________________________________________
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Recomandari / exercitii: __________________________________________________________________

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Sedinta:______ / Data:_________________

Progrese / schimbari observate de la ultima sedinta: ___________________________________________

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Proceduri aplicate: _______________________________________________________________________

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Comentarii / observatii:__________________________________________________________________
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Recomandari / exercitii: __________________________________________________________________

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