Upper Extremity Pre-Exam Form
Chapman Location
For patients experiencing pain/injury in any part of the upper extremity:  shoulder, elbow, wrist, hand, or upper and lower arm.  Please complete to the best of your ability and submit.

The state of Kansas is a “Direct Access” state for Physical Therapy. 
​ You can begin physical therapy with or without a referral from a physician. ​

Now with 2 Locations to Better Serve You!
ABILENE:
103 Northwest 15th Street
Abilene, KS 67410
Phone:  785-263-3646
FAX:  785-263-3689

HOURS:  
​Monday - Friday
8 a.m. - 5 p.m.
CHAPMAN:
​1030 North Marshall, Suite B
Chapman, KS 67431
Phone:  785-922-4016
FAX:  785-922-4018

HOURS:
​Monday - Friday
8 a.m. - 5 p.m.