Neck Pre-Exam Form in Chapman
It might have started as a stiff morning. Now it owns your desk setup, your pillow and the way you back out of a parking space. These are the questions your therapist will ask at our Chapman clinic, listed here so you can think them over before you arrive.
What your neck pre-exam covers.
A neck rarely complains where the trouble actually is. It sends the message to the shoulder blade, to an elbow, to two fingers, to a headache that starts at the base of the skull. Where you feel it and where it comes from are separate questions, and the second one decides the treatment.
So look these over before your visit and answer what you can. Nothing is submitted on this page and nothing needs printing. When you are ready to book, the form further down the page is all of it.
Where it sits, where it refers
Base of the skull, the side of the neck, the top of the shoulder, or the shelf between the shoulder blades. Then whether it stays in the neck or travels: into the shoulder blade, down the outside of the arm, into the elbow, into the hand. Note the side, and whether it is always that same side.
Neck pain →The hand: numbness, weakness, grip
Which fingers tingle or go numb, since the pattern points to a particular nerve root. Whether anything has slipped out of your hand recently. Whether jar lids, keys and buttons have become a struggle. Whether the arm wakes you at night and needs shaking out. Small details that change the plan.
Elbow, wrist & hand →Headaches and positions
A headache that begins at the base of the skull and works forward behind the eye is often a neck problem in disguise, so tell us about those. Then the positions: hours at a desk, a laptop on the kitchen table, a phone held low in your lap, long drives, and how you sleep, pillows included.
Request an appointment →Trauma history and imaging
Whiplash, a car accident, a fall, a collision on a field, including the one from years back that you assumed had settled. Any previous neck surgery. Any imaging, and what the X-ray, MRI or CT report actually said. Then what has been tried already, and what changed after each attempt.
Call (785) 922-4016 →What to bring to your first visit
- Your prescription, if a physician has already written you one
- Your driver’s licence or another photo ID
- Your insurance cards, or your Worker’s Comp or auto claim information
- A list of your medications with the dosage and how often you take them
- Copies of any X-ray, MRI or CT reports of your neck
- Your personal calendar, so we can schedule the rest of your visits before you leave
If this began with a car accident, bring the claim details too. Kansas direct access means most patients can start physical therapy without a physician referral. Some insurance plans still require one for coverage, so we verify your specific plan before your first visit and tell you exactly where you stand.
Your Chapman clinic
Tues and Thurs, 7:20 am to 5:00 pm
If looking down at a page is the very thing that sets it off, do not sit and write this out. Call (785) 922-4016 and answer it on the phone, or come in a few minutes early and go through it with us at the front desk. Nobody is turned away for arriving unprepared. Use the form below and we will call you back with a time.