Free Injury Screen

Welcome to Mount Si Physical Therapy! We are offering a free Injury Screen to assess your symptoms and determine if further evaluation and intervention are required. To proceed with the screening, please read and provide your consent below:

  • I understand that the purpose of the free Injury Screen is to assess whether I have sustained an injury, experience pain, or have a condition that necessitates further evaluation and intervention by a Doctor in Physical Therapy at Mount Si Physical Therapy. The evaluation may involve asking questions about the nature and severity of my symptoms, as well as a quick physical examination.

  • I acknowledge that the results of the Injury Screen will be used by my Doctor in Physical Therapy to recommend the most appropriate course of action and treatment plan, if necessary. I understand that the evaluation and treatment recommendations come with their own set of risks, benefits, and alternative options.

  • I understand that I retain the right to decline the treatment at any time, should I choose to do so.

By clicking the "Submit" button below, I confirm that I have read and understood the above information, and I voluntarily consent to conducting a screening assessment at Mount Si Physical Therapy. I also authorize Mount Si Physical Therapy to collect and use my email address for communication purposes related to my injury evaluation and any subsequent treatment recommendations, as well as any photographs taken during the screening, to be used for marketing purposes.

* By submitting this form, I agree to receive newsletters and other email communications from Mount Si Physical Therapy, as well as to allow the use of any photos taken during the free injury screen for marketing purposes.