01487 843 844 
info@hardingphysiotherapy.co.uk 

Pre-Appointment Screening Form 

 
You can book an appointment with Harding Physiotherapy by calling the clinic on 01487 843 844 or emailing info@hardingphysiotherapy.co.uk.  
 
Prior to your appointment, please complete the Pre-Appointment form below. This information helps us to carry out our risk assessment, but more importantly helps us to understand more about why you contacted us, which enables us to allocate you to the therapist best placed to meet your treatment requirements. 
 
If calling the clinic we can go through this form with you over the phone. 
 
YOUR CONTACT DETAILS 
ABOUT YOU 
ABOUT YOUR CURRENT PAIN / INJURY / SYMPTOMS 
Tell us why you have booked an appointment 
This form will be sent to our team when you click 'submit'. 
About Harding Physiotherapy 
 
Our Team 
Conditions  
& Treatments 
 
FAQs 
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