Headache Intake Questionnaire (Fillable PDF)

Headache Intake Questionnaire (Fillable PDF)


This questionnaire is ideal for physical therapists treating headache patients because it :

  • provides you with a thorough picture of the problem prior to beginning the evaluation

  • builds trust with the patent because you are “asking all the right questions”

The digital download includes:

  • Two pages of questions pertaining specifically to cervicogenic headache and migraine conditions

  • A file in a fillable PDF format that can be emailed, printed, or accessed with adobe acrobat reader

  • Space in the form to upload your personal business information and logo

Note: This is not an evaluation form, this is a patient questionnaire.

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