BUPTC Clinic Forms

Intake Forms

Please complete our general intake packet and appropriate questionnaire below prior to your first appointment.

• General intake:
  • For new onset symptoms: BU Physical Therapy Intake A
  • For symptoms lasting longer than three months: BU Physical Therapy Intake B
• Shoulder/Arm Questionnaire
• Concussion Questionnaire
• Low Back Questionnaire
• Neck Questionnaire
• Lower Body Questionnaire
• Knee Questionnaire
• Global Rating Questionnaire

Release Authorization Form

If you would like a copy of your medical records, please fill out the Release Authorization Form and fax to 617-358-3710 or email to buptc@bu.edu.