Julie Onofrio, LMP
1402 Third Ave. Suite 1428
Seattle, WA 98101
206-623-1391
To: _____________________________
Progress Report as of : ___/___/____
Regarding:_______________________
Number of treatments:______________
Current Rx expires:________________
Overall Patient Progress is: ___Poor ___Marginal
___Good ___Excellent
Subjective and Objective Observations
| |
Left
|
Right
|
No current problem
|
Improving
|
Not
Improving
|
Increased
Symptoms
|
|
Neck
|
|
|
|
|
|
|
|
Shoulder
|
|
|
|
|
|
|
|
Arm
|
|
|
|
|
|
|
|
Upper Back
|
|
|
|
|
|
|
|
Mid- Back
|
|
|
|
|
|
|
|
Low Back
|
|
|
|
|
|
|
|
Pelvis
|
|
|
|
|
|
|
|
Hips
|
|
|
|
|
|
|
|
Legs
|
|
|
|
|
|
|
Patient rates their stress level as: ___Low ___Moderate
___ High
Treatment Plan_________________________________________________________________
______________________________________________________________________________________
Other Concerns/Comments:_______________________________________________________
_____________________________________________________________________________
Thank you for your referral.
Please contact me with any questions.
