{"id":1274,"date":"2017-01-18T11:01:15","date_gmt":"2017-01-18T16:01:15","guid":{"rendered":"http:\/\/plankdev2.com\/?page_id=1274"},"modified":"2024-09-17T21:50:51","modified_gmt":"2024-09-18T01:50:51","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/lowcountrypt.com\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"<div id='av_section_1'  class='avia-section av-1ra9k5m-ce8fb5ce6c05cb16eac408c8a90a8e42 main_color avia-section-default avia-no-border-styling  avia-builder-el-0  el_before_av_section  avia-builder-el-first  avia-bg-style-scroll container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1274'><div class='entry-content-wrapper clearfix'>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-38rruy-3420befefeae1f7f47104206d2058281\">\n#top .av-special-heading.av-38rruy-3420befefeae1f7f47104206d2058281{\npadding-bottom:10px;\nfont-size:46px;\n}\nbody .av-special-heading.av-38rruy-3420befefeae1f7f47104206d2058281 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-38rruy-3420befefeae1f7f47104206d2058281 .av-special-heading-tag{\nfont-size:46px;\n}\n.av-special-heading.av-38rruy-3420befefeae1f7f47104206d2058281 .av-subheading{\nfont-size:15px;\n}\n\n@media only screen and (min-width: 480px) and (max-width: 767px){ \n#top #wrap_all .av-special-heading.av-38rruy-3420befefeae1f7f47104206d2058281 .av-special-heading-tag{\nfont-size:0.8em;\n}\n}\n\n@media only screen and (max-width: 479px){ \n#top #wrap_all .av-special-heading.av-38rruy-3420befefeae1f7f47104206d2058281 .av-special-heading-tag{\nfont-size:0.8em;\n}\n}\n<\/style>\n<div  class='av-special-heading av-38rruy-3420befefeae1f7f47104206d2058281 av-special-heading-h1 blockquote modern-quote modern-centered  avia-builder-el-1  el_before_av_hr  avia-builder-el-first  av-inherit-size'><h1 class='av-special-heading-tag'  itemprop=\"headline\"  >Patient Forms<\/h1><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1p4guje-f4163e93bbc838a011ec0eefc3f91da3\">\n#top .hr.av-1p4guje-f4163e93bbc838a011ec0eefc3f91da3{\nmargin-top:20px;\nmargin-bottom:20px;\n}\n.hr.av-1p4guje-f4163e93bbc838a011ec0eefc3f91da3 .hr-inner{\nwidth:50px;\nborder-color:#40a8e4;\n}\n<\/style>\n<div  class='hr av-1p4guje-f4163e93bbc838a011ec0eefc3f91da3 hr-custom  avia-builder-el-2  el_after_av_heading  el_before_av_two_fifth  hr-center hr-icon-no'><span class='hr-inner inner-border-av-border-fat'><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1mop4je-11db2cea7577407235776c09aa31e450\">\n.flex_column.av-1mop4je-11db2cea7577407235776c09aa31e450{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\npadding:20px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-1mop4je-11db2cea7577407235776c09aa31e450 av_two_fifth  avia-builder-el-3  el_after_av_hr  el_before_av_one_half  first flex_column_div '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1kxej7u-0962681ca62195b5dd1217070a6a8221\">\n.avia-image-container.av-1kxej7u-0962681ca62195b5dd1217070a6a8221 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-1kxej7u-0962681ca62195b5dd1217070a6a8221 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-1kxej7u-0962681ca62195b5dd1217070a6a8221 av-styling- avia-align-center  avia-builder-el-4  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/LC_paperwork.pdf\" class='avia_image' ><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1k046sa-fdcab4616588d9cc78c566949a7dc0b4\">\n#top .av_textblock_section.av-1k046sa-fdcab4616588d9cc78c566949a7dc0b4 .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-1k046sa-fdcab4616588d9cc78c566949a7dc0b4'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline;\"><a href=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/LC_paperwork.pdf\">New Patient Packet<\/a><\/div>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1i3cep6-3781edde3ecb3883cba4928d053ddd47\">\n.flex_column.av-1i3cep6-3781edde3ecb3883cba4928d053ddd47{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-1i3cep6-3781edde3ecb3883cba4928d053ddd47 av_one_half  avia-builder-el-6  el_after_av_two_fifth  el_before_av_one_fourth  flex_column_div av-zero-column-padding '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1g94sii-94fa65b58fd3d4801df4f26694508306\">\n#top .av_textblock_section.av-1g94sii-94fa65b58fd3d4801df4f26694508306 .avia_textblock{\nfont-size:18px;\n}\n<\/style>\n<section  class='av_textblock_section av-1g94sii-94fa65b58fd3d4801df4f26694508306'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"display: none;\">For your convenience, click on the icon(s) to download a printable .pdf version of our New Patient Packet. This will give you the ability to fill this out before you arrive at our office.<\/p>\n<p>If you are having difficulty completing the online new patient registration form sent to you via email when your appointment was scheduled, please click the link below to access our new patient paper registration form. Please complete this form and bring the form with you to your first visit.<\/p>\n<p>The packet includes the following:<\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1e7xbyy-7f0bebc32a9e08099d33b1cb53289dda\">\n#top .avia-icon-list-container.av-1e7xbyy-7f0bebc32a9e08099d33b1cb53289dda .iconlist_icon{\ncolor:#00aba2;\n}\n<\/style>\n<div  class='avia-icon-list-container av-1e7xbyy-7f0bebc32a9e08099d33b1cb53289dda  avia-builder-el-8  el_after_av_textblock  avia-builder-el-last '><ul class='avia-icon-list avia_animate_when_almost_visible avia-icon-list-left av-iconlist-small av-1e7xbyy-7f0bebc32a9e08099d33b1cb53289dda avia-iconlist-animate'>\n<li><div class='iconlist_icon av-1cog5tm-6568a732628619df99fe38f04c026044 avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Welcome Letter<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<li><div class='iconlist_icon av-1ak3qx6-c7f23128c16bd464f6f8abd78dd903fc avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Locations, Maps and Directions<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<li><div class='iconlist_icon av-18yak2y-f41828e59a64f1dfa9b451df0c4b95c3 avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Registration Form<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<li><div class='iconlist_icon av-18fc46i-1033b1aa896254664b003d5c9f00fa37 avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Insurance Information Form<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<li><div class='iconlist_icon av-16b2x0q-726eb87052097897a6eed185440badee avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Complaint\/Symptom Information Form<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<li><div class='iconlist_icon av-14d2rpm-edd0a15eef1fe6f37e6df8eb76acdb8d avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Medical History Form<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<li><div class='iconlist_icon av-13c16ga-ec19a1d54020f6b6fc85877c18899261 avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Protected Health Information Release<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<li><div class='iconlist_icon av-11pchcq-c9e771a421c771f06d75d447f4537492 avia-font-entypo-fontello'><span class='iconlist-char' aria-hidden='true' data-av_icon='\ue885' data-av_iconfont='entypo-fontello'><\/span><\/div><article class=\"article-icon-entry av-iconlist-empty\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconlist_content_wrap\"><header class=\"entry-content-header\"><div class='av_iconlist_title iconlist_title_small  '  itemprop=\"headline\" >Function Scale Pertaining to Your Injury or Ailment (See Forms and Definitions Below)<\/div><\/header><div class='iconlist_content '  itemprop=\"text\" ><\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><div class=\"iconlist-timeline\"><\/div><\/li>\n<\/ul><\/div><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1mop4je-4-d741a1812d715f39706ce79a2e530d20\">\n.flex_column.av-1mop4je-4-d741a1812d715f39706ce79a2e530d20{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\npadding:20px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-1mop4je-4-d741a1812d715f39706ce79a2e530d20 av_one_fourth  avia-builder-el-9  el_after_av_one_half  avia-builder-el-last  disablex first flex_column_div column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1kxej7u-3-55923678764a537d119f9409ff382b5a\">\n.avia-image-container.av-1kxej7u-3-55923678764a537d119f9409ff382b5a img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-1kxej7u-3-55923678764a537d119f9409ff382b5a .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-1kxej7u-3-55923678764a537d119f9409ff382b5a av-styling- avia-align-center  avia-builder-el-10  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/Covid-19-Liabaility-Release-Waiver.pdf\" class='avia_image'  target=\"_blank\"  rel=\"noopener noreferrer\"><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1k046sa-2-2cb2724c4a9c011892d73455d94a57d3\">\n#top .av_textblock_section.av-1k046sa-2-2cb2724c4a9c011892d73455d94a57d3 .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-1k046sa-2-2cb2724c4a9c011892d73455d94a57d3'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline;\"><a href=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/Covid-19-Liabaility-Release-Waiver.pdf\">Current Patient COVID-19 Liability Release Waiver<\/a><\/div>\n<\/div><\/section><\/p><\/div><\/div><\/div><\/main><!-- close content main element --><\/div><\/div><div id='av_section_2'  class='avia-section av-zjpzi2-eab77ad8a10409287ab3684e6e750731 main_color avia-section-default avia-no-border-styling  avia-builder-el-12  el_after_av_section  avia-builder-el-last  avia-bg-style-scroll container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1274'><div class='entry-content-wrapper clearfix'>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3didu2-df67fefaf946005a189e5ff624569695\">\n#top .av-special-heading.av-3didu2-df67fefaf946005a189e5ff624569695{\npadding-bottom:10px;\ncolor:#4ecac2;\n}\nbody .av-special-heading.av-3didu2-df67fefaf946005a189e5ff624569695 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-3didu2-df67fefaf946005a189e5ff624569695 .special-heading-inner-border{\nborder-color:#4ecac2;\n}\n.av-special-heading.av-3didu2-df67fefaf946005a189e5ff624569695 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-3didu2-df67fefaf946005a189e5ff624569695 av-special-heading-h3 custom-color-heading blockquote modern-quote modern-centered  avia-builder-el-13  el_before_av_heading  avia-builder-el-first  av-linked-heading'><h3 class='av-special-heading-tag'  itemprop=\"headline\"  ><a class=\"av-heading-link\" href=\"https:\/\/lowcountrypt.com\/virtual-consent\/\">Read here the Virtual Consent<\/a><\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1yzbq2-7c1890a401db8c09103c611012ea97db\">\n#top .av-special-heading.av-1yzbq2-7c1890a401db8c09103c611012ea97db{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-1yzbq2-7c1890a401db8c09103c611012ea97db .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-1yzbq2-7c1890a401db8c09103c611012ea97db .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-1yzbq2-7c1890a401db8c09103c611012ea97db av-special-heading-h3 blockquote modern-quote modern-centered  avia-builder-el-14  el_after_av_heading  el_before_av_hr '><h3 class='av-special-heading-tag'  itemprop=\"headline\"  >In addition to the patient packet, please download and fill out the form pertaining to the location of your injury or ailment.<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-vthdqi-99b52358a3233a45fed241279f569c92\">\n#top .hr.hr-invisible.av-vthdqi-99b52358a3233a45fed241279f569c92{\nheight:25px;\n}\n<\/style>\n<div  class='hr av-vthdqi-99b52358a3233a45fed241279f569c92 hr-invisible  avia-builder-el-15  el_after_av_heading  el_before_av_one_fifth '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-v155ca-294f33dc6f6bed708c57c7253cd46501\">\n.flex_column.av-v155ca-294f33dc6f6bed708c57c7253cd46501{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-v155ca-294f33dc6f6bed708c57c7253cd46501 av_one_fifth  avia-builder-el-16  el_after_av_hr  el_before_av_one_fifth  first flex_column_div av-zero-column-padding '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-sl82fu-9c5a690b7220ae061ad1e98297828068\">\n.avia-image-container.av-sl82fu-9c5a690b7220ae061ad1e98297828068 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-sl82fu-9c5a690b7220ae061ad1e98297828068 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-sl82fu-9c5a690b7220ae061ad1e98297828068 av-styling- avia-align-center  avia-builder-el-17  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"\/wp-content\/uploads\/Dizziness-Handicap-Inventory.pdf\" class='avia_image' target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-rtqwve-4e5ffd01b59830e20de563a6726295db\">\n#top .av_textblock_section.av-rtqwve-4e5ffd01b59830e20de563a6726295db .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-rtqwve-4e5ffd01b59830e20de563a6726295db'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline; line-height: 20px;\"><strong>Dizziness Handicap Inventory<\/strong><\/div>\n<div id=\"form-desc\">Diagnosis BPPV \/ Vertigo \/ Dizziness<\/div>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ppausq-3959c2ed3b5e3024a0bd6550dfd8e82e\">\n.flex_column.av-ppausq-3959c2ed3b5e3024a0bd6550dfd8e82e{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-ppausq-3959c2ed3b5e3024a0bd6550dfd8e82e av_one_fifth  avia-builder-el-19  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div av-zero-column-padding '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-of9u0q-61b59d60fa3c5308f06beb89af0a3c76\">\n.avia-image-container.av-of9u0q-61b59d60fa3c5308f06beb89af0a3c76 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-of9u0q-61b59d60fa3c5308f06beb89af0a3c76 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-of9u0q-61b59d60fa3c5308f06beb89af0a3c76 av-styling- avia-align-center  avia-builder-el-20  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"\/wp-content\/uploads\/Lower-Extremity-Functional-Scale.pdf\" class='avia_image' target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-lucxcq-38c9d3dfc32bc8ad3ddc0999790f19bc\">\n#top .av_textblock_section.av-lucxcq-38c9d3dfc32bc8ad3ddc0999790f19bc .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-lucxcq-38c9d3dfc32bc8ad3ddc0999790f19bc'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline; line-height: 20px;\"><strong>Lower Extremity Functional Scale<\/strong><\/div>\n<div id=\"form-desc\">Hip, Thigh, Leg Ankle, Foot<\/div>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kb5tuy-e6078c3470b505fc8a4932debe01e17d\">\n.flex_column.av-kb5tuy-e6078c3470b505fc8a4932debe01e17d{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-kb5tuy-e6078c3470b505fc8a4932debe01e17d av_one_fifth  avia-builder-el-22  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div av-zero-column-padding '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ioqzp6-129e58daa59e22007c152ab1e5f4941a\">\n.avia-image-container.av-ioqzp6-129e58daa59e22007c152ab1e5f4941a img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-ioqzp6-129e58daa59e22007c152ab1e5f4941a .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-ioqzp6-129e58daa59e22007c152ab1e5f4941a av-styling- avia-align-center  avia-builder-el-23  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"\/wp-content\/uploads\/Neck-Index.pdf\" class='avia_image' target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-hfjjqi-d99233d1db4957d128d0bb4199034817\">\n#top .av_textblock_section.av-hfjjqi-d99233d1db4957d128d0bb4199034817 .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-hfjjqi-d99233d1db4957d128d0bb4199034817'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline; line-height: 20px;\"><strong>Neck Index<\/strong><\/div>\n<div id=\"form-desc\">\n<div id=\"form-desc\">Neck, Upper Trap, Cervical Spine<\/div>\n<div><\/div>\n<\/div>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1l3a6i-f8933defa302653fb1f153aa3c5fcf0f\">\n.flex_column.av-1l3a6i-f8933defa302653fb1f153aa3c5fcf0f{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-1l3a6i-f8933defa302653fb1f153aa3c5fcf0f av_one_fifth  avia-builder-el-25  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div av-zero-column-padding '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-dqedq2-184522078337ca2886240f94e8cc91c5\">\n.avia-image-container.av-dqedq2-184522078337ca2886240f94e8cc91c5 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-dqedq2-184522078337ca2886240f94e8cc91c5 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-dqedq2-184522078337ca2886240f94e8cc91c5 av-styling- avia-align-center  avia-builder-el-26  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"\/wp-content\/uploads\/Oswestry-Lower-Back-Inventory.pdf\" class='avia_image' target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-c8ai9m-ff13dadf638e47c9af0c64a00271388a\">\n#top .av_textblock_section.av-c8ai9m-ff13dadf638e47c9af0c64a00271388a .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-c8ai9m-ff13dadf638e47c9af0c64a00271388a'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline; line-height: 20px;\"><strong>Oswestry Lower Back Inventory<\/strong><\/div>\n<div id=\"form-desc\">Low Back Pain, Sciatica, Radiculopathy<\/div>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-aac2oq-43278033cd521b73a45b62a2ab2a84d8\">\n.flex_column.av-aac2oq-43278033cd521b73a45b62a2ab2a84d8{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-aac2oq-43278033cd521b73a45b62a2ab2a84d8 av_one_fifth  avia-builder-el-28  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div av-zero-column-padding '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-wh0be-c8a335663c93c6b99acfe8dfca11499b\">\n.avia-image-container.av-wh0be-c8a335663c93c6b99acfe8dfca11499b img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-wh0be-c8a335663c93c6b99acfe8dfca11499b .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-wh0be-c8a335663c93c6b99acfe8dfca11499b av-styling- avia-align-center  avia-builder-el-29  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"\/wp-content\/uploads\/Quick-DASH-01.22.19-1.pdf\" class='avia_image' target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-s8ehm-a9a97df4041c5f08f8e5f380af8d6a7a\">\n#top .av_textblock_section.av-s8ehm-a9a97df4041c5f08f8e5f380af8d6a7a .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-s8ehm-a9a97df4041c5f08f8e5f380af8d6a7a'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline; line-height: 20px;\"><strong>Quick Dash<br \/>\n<\/strong><\/div>\n<div id=\"form-desc\">Shoulder, Elbow, Wrist, Hand, Finger<\/div>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-6fpah6-c1a1ea48780082df8970ea9016c1fe2f\">\n.flex_column.av-6fpah6-c1a1ea48780082df8970ea9016c1fe2f{\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\nborder-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-6fpah6-c1a1ea48780082df8970ea9016c1fe2f av_one_fifth  avia-builder-el-31  el_after_av_one_fifth  avia-builder-el-last  first flex_column_div av-zero-column-padding column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-43avre-bf7dbe36ace808755563a62129a23bf2\">\n.avia-image-container.av-43avre-bf7dbe36ace808755563a62129a23bf2 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-43avre-bf7dbe36ace808755563a62129a23bf2 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-43avre-bf7dbe36ace808755563a62129a23bf2 av-styling- avia-align-center  avia-builder-el-32  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><a href=\"\/wp-content\/uploads\/Knee-Outcome-Survey-KOS5.pdf\" class='avia_image' target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" class='wp-image-1360 avia-img-lazy-loading-not-1360 avia_image ' src=\"https:\/\/lowcountrypt.com\/wp-content\/uploads\/pdf.jpg\" alt='' title='pdf'  height=\"223\" width=\"180\"  itemprop=\"thumbnailUrl\"  \/><\/a><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-28srhm-e90db7d49f89b2a1d8b1bfa087a1f3f1\">\n#top .av_textblock_section.av-28srhm-e90db7d49f89b2a1d8b1bfa087a1f3f1 .avia_textblock{\ncolor:#00aba2;\n}\n<\/style>\n<section  class='av_textblock_section av-28srhm-e90db7d49f89b2a1d8b1bfa087a1f3f1'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><div style=\"text-align: center; text-decoration: underline; line-height: 20px;\"><strong>Knee Outcome Survey<br \/>\n<\/strong><\/div>\n<div id=\"form-desc\">\u00a0Activities for daily living (For knee patients only)<\/div>\n<\/div><\/section><\/p><\/div>\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='after_section_2'  class='main_color av_default_container_wrap container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page 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