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      • Non-bacterial Prostatitis
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New Patient Forms

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  • New Patient Forms

All patients will need to fill out at least 3 forms for the initial evaluation appointment (first visit). Please print these forms, fill them out, and bring them to your first appointment at either the Portland or Vancouver location.

  1. Intake Form
  2. Financial Policies Form
  3. Choose one form below that most closely relates to your symptoms.

Orthopedic patients

  1. Low Back Pain
  2. Neck or Upper/Mid Back Pain
  3. Hip, Knee, Ankle
  4. Shoulder, Elbow, Hand
  5. Jaw Pain
  6. Balance, Post-Stroke, Difficulty with Activities of Daily Living

Women’s Health patients

  1. Pelvic Pain Issues
  2. Urinary Incontinence
  3. Interstitial Cystitis
  4. Prolapse, Cystocele, Rectocele, Constipation

Men’s Health patients

  1. Prostatitis, Pelvic Pain, Urgency, Frequency
  2. Urinary Incontinence

Notice of Non-Discrimination and Accessibility Rights

What We Treat

  • Arthritis and Joint Pain
  • Balance Deficits
  • Carpal Tunnel Syndrome
  • Chronic Pain
  • EBPT Blog
  • Fibromyalgia
  • Foot and Ankle Pain
  • Headaches
  • Hip Pain
  • Incontinence
  • Knee Pain
  • Low Back Pain
  • Motor Vehicle Accident
  • Neck Pain
  • Osteoporosis
  • Overuse Injuries
  • Pain Related to Pregnancy
  • Pelvic Pain
  • Post-surgical Rehabilitation
  • Sciatica
  • Shoulder Pain
  • Sports Injuries
  • Worker's Comp

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    Portland

    2250 NW Flanders St., Ste. 112
    Portland
    OR
    97210
    (503) 224-1947
    scheduling@ebptllc.com

    Vancouver

    1306 Main St.
    Vancouver
    WA
    98660
    (360) 314-2384
    scheduling@ebptllc.com
    Everybody Physical Therapy
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