Monitor and Document Your Journey Back to Peak Performance
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Name: ___________________ Date of Injury: //___ Type of Injury: _______________ Sport: _______________
Rate your pain on a scale of 0-10 (0 = no pain, 10 = worst pain)
Date | Pain Level | Activity Level | Notes |
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Date | Measurement | % of Normal Side | Therapist Initials |
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Exercise Type: _______________
Date | Weight/Resistance | Sets x Reps | Notes |
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Short-term: ____________________ Mid-term: ____________________ Long-term: ____________________
Date | Exercises Completed | Next Appointment |
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