Appointment Guideline
- If you are more than 10 minutes late, you may be asked to reschedule
- Cancellations and requests for rescheduling must be given 24 hours before the appointment time
- If you cancel more than 3 appointments or you do not show for more than 2 appointments within 10 scheduled sessions for any reason, you will automatically be removed from the therapy schedule and may be discharged. To restart therapy, you will need a new prescription from your physician.
PLEASE INFORM US IF YOU BEGIN TAKING ANY NEW MEDICATIONS DURING YOUR COURSE OF THERAPY
Evaluación Del Riesgo De Caídas
Enfermedades transmisibles
INFÓRMENOS SI COMIENZA A TOMAR MEDICAMENTOS NUEVOS DURANTE SU TERAPIA
How often do you have a bowel movement?
Appointment Guidelines
- If you are more than 10 minutes late, you may be asked to reschedule
- Cancellations and requests for rescheduling must be given 24 hours before the appointment time
- If you cancel more than 3 appointments or you do not show for more than 2 appointments within 10 scheduled sessions for any reason, you will automatically be removed from the therapy schedule and may be discharged. To restart therapy, you will need a new prescription from your physician.
PLEASE INFORM US IF YOU BEGIN TAKING ANY NEW MEDICATIONS DURING YOUR COURSE OF THERAPY
¿Con qué frecuencia mueve los intestinos?
Evaluación de riesgo de caídas
Enfermedades transmisibles
Directrices de citas
* Si llega más de 10 minutos tarde, le podrían pedir que reprograme su cita
* Las cancelaciones y solicitudes de reprogramación deben realizarse 24 horas antes de la hora de la cita
* Si cancela más de 3 citas o si falta a más de 2 citas de 10 citas programadas, por el motivo que fuera, será dado de baja del cronograma
de terapia y será eliminado del cronograma de terapia y dado de alta. Para reiniciar la terapia, necesitará una nueva receta de su médico.
INFÓRMENOS SI COMIENZA A TOMAR MEDICAMENTOS NUEVOS DURANTE SU TERAPIA
Pelvic/Abdominal Surgical History (i.e. hysterectomy, adhesions, endometriosis, etc.)
/ 21 = Sum scores from box A + B + C
How often do you have a bowel movement?
Appointment Guidelines
- If you are more than 10 minutes late, you may be asked to reschedule
- Cancellations and requests for rescheduling must be given 24 hours before the appointment time
- If you cancel more than 3 appointments or you do not show for more than 2 appointments within 10 scheduled sessions for any reason, you will automatically be removed from the therapy schedule and may be discharged. To restart therapy, you will need a new prescription from your physician.
PLEASE INFORM US IF YOU BEGIN TAKING ANY NEW MEDICATIONS DURING YOUR COURSE OF THERAPY
Historial de cirugía pélvica/abdominal (por ejemplo, histerectomía, adhesiones, endometriosis, etc.)
Historial de embarazo / trabajo de parto / parto (si corresponde)
Problemas de infertilidad (si corresponde)
Síntomas de la vejiga (si corresponde)
Formulario corto de ICIQ-UI: marque su respuesta
/ 21 = la suma de las puntuaciones del cuadro A +B +C
¿Con qué frecuencia mueve los intestinos?
Marque TODAS las actividades que causan o aumentan su dolor
Evaluación de riesgo de caídas
Enfermedades transmisibles
Directrices de citas
- Si llega más de 10 minutos tarde, le podrían pedir que reprograme su cita
- Las cancelaciones y solicitudes de reprogramación deben realizarse 24 horas antes de la hora de la cita
- Si cancela más de 3 citas o si falta a más de 2 citas de 10 citas programadas, por el motivo que fuera, será dado de baja del cronograma de terapia y dado de alta del hospital. Para recomenzar la terapia, necesitará que su médico le haga una receta nueva.
INFÓRMENOS SI COMIENZA A TOMAR MEDICAMENTOS NUEVOS DURANTE SU TERAPIA
C.Appointment Guidelines
- If you are more than 10 minutes late, you may be asked to reschedule
- Cancellations and requests for rescheduling must be given 24 hours before the appointment time
- If you cancel more than 3 appointments or you do not show for more than 2 appointments within 10 scheduled sessions for any reason, you will automatically be removed from the therapy schedule and may be discharged. To restart therapy, you will need a new prescription from your physician.
PLEASE INFORM US IF YOU BEGIN TAKING ANY NEW MEDICATIONS DURING YOUR COURSE OF THERAPY
B.Evaluación Del Riesgo De Caídas
Enfermedades transmisibles
C.Directrices De Citas
- Si llega más de 10 minutos tarde, le podrían pedir que reprograme su cita
- Las cancelaciones y solicitudes de reprogramación deben realizarse 24 horas antes de la hora de la cita
- Si cancela más de 3 citas o si falta a más de 2 citas de 10 citas programadas, por el motivo que fuera, será dado de baja del cronograma de terapia. Para reiniciar el tratamiento, necesitará una nueva receta de su médico.
INFÓRMENOS SI COMIENZA A TOMAR MEDICAMENTOS NUEVOS DURANTE SU TERAPIA
PLEASE INFORM US IF YOU BEGIN TAKING ANY NEW MEDICATIONS DURING YOUR COURSE OF THERAPY
Communicable Diseases (patient and/or guardian)
Appointment Guidelines
- If you are more than 10 minutes late, you may be asked to reschedule
- Cancellations and requests for rescheduling must be given 24 hours before the appointment time
- If you cancel more than 3 appointments or you do not show for more than 2 appointments within 10 scheduled sessions for any reason, you will automatically be removed from the therapy schedule and may be discharged. To restart therapy, you will need a new prescription from your doctor.