A concise record of today's session: pre-treatment status, interventions delivered, response, and the plan for the next visit.
[ ] In-clinic [ ] Home visit [ ] Telerehab
[ ] Good — restful [ ] Fair — woken once or twice [ ] Poor — disrupted by symptoms
New symptoms or changes since last visit:
[ ] Poor — disrupted by symptoms
New symptoms or changes since the last visit:
Home exercise program adherence (1 = none, 5 = full):
Other observation (skin, swelling, sole-of-foot, etc.):
Modality and parameters (e.g. "Ultrasound 1MHz 1.5W/cm² 8 min" or "TENS 80Hz 30 min").
Specific techniques, regions, grades, and patient response:
Therapeutic Exercise Done
Exercise — sets × reps — resistance / weight — form notes.
Total exercise time (minutes):
Functional / Task Training
Task simulations, gait training, return-to-activity drills:
Patient Response & Tolerance
Pain after treatment (0-10):
Pain change during / after session:
Performance changes (range, strength, control):
[ ] None [ ] Dizziness / lightheadedness [ ] Increased pain [ ] Soreness anticipated post-session [ ] Other (describe below)
[ ] Dizziness / lightheadedness
[ ] Muscle soreness expected after the session
[ ] Other (please describe below)
Education / Home Exercise Program Update
Changes to home program (added / removed / modified):
New exercises or progressions introduced today:
Focus areas, modalities to repeat, progressions to introduce:
Signing therapist (printed name):
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[ ] This note accurately reflects the session delivered today
Great work today. Stay consistent with the home program and message us if anything feels off before the next visit.