Health Form

Please complete and return this form to me prior to your first appointment. It will give me an outline of the reason for attending and your general health so that I can provide you with the most appropriate care and treatment. All information will be kept confidential. I look forward to meeting you in clinic. Barry

Full Name *

Contact Number *

Email *

Home Address

Date of Birth

Reason for Visit

GP Name and Number

(in case of emergency)

Next of Kin

(in case of emergency)

Do you smoke?

Are you pregnant?

Occupation

Please describe your job in terms of physicality, are you desk bound or on the move?

Have you attended a GP or another Medical Practitioner for this problem?

How and when did your injury happen?

Please list any surgeries (and their dates) or any conditions for which you have been hospitalised in the past few years. *

Please describe any injuries (and dates of occurrence) for which you have been treated in the past few years (fractures, dislocations, sprains)

Are you taking any Medication(s)? If so, for what condition(s)?

Medical History

Have you had previous physiotherapy for this (or another) condition? Did you make a complete recovery? When did you attend for therapy?

Do you play sport or exercise? How intense and how often?

What is your goal in attending for physical therapy? What outcome would you like to achieve upon conclusion of therapy?

e.g. to be pain free, to run a marathon, to get back to team sport etc.

Kirwan Physical Therapy Clinic

5.0

Based on 10 reviews

review us on

Adammurray 08

09:05 10 Jul 20

My appointment with Kirwan Physical was excellent, spent time to understand the... reason for my issue and immediately addressed the underlying problem and provided me with a programme to ensure that it does not re-occur. First nights sleep in months with no pain, thanks,read more

Irene Bruce

16:23 25 Nov 19

Barry is a very professional Physical Therapist who puts every effort into... resolving your injuries. He has treated me several times for various injuries and he has always managed to get great results. He is totally committed to his profession and his clients.read more

Warren Mowlds

11:44 01 Sep 18

Barry gets great results Very friendly and professional too. I'd never go... anywhere else.read more

Vinnie Dermody

14:44 03 Apr 17

Excellent service. I was having issues with tension in my upper back & Barry... pinpointed the source and ironed it out real good. Feeling 100%. Highly recommended :-)read more

Tom Garvey

16:09 17 Jan 17

What most impressed me about Barry was his ability to digest what I was telling... him and translate that into results. Not to mention those magic hands. Barry is very approachable and a really good guy to top it all off.read more

Adrian Corr

11:00 27 Oct 16

I have been attending Barry for many years for various muscular and spinal... issues of the back . I find him to be a dedicated therapist applying his many years of expertise and skills to arrive at a pain free or management outcome . He respects the clients viewpoint and experiences of pain and incorporates into his treatment . He displays an empathetic approach and general positive attitude to successful outcomes . As someone whom has experienced quire resistant issues at times I always find that Barry works tirelessly in treatment to achieve results . He also advises on what techniques after treatment that clients should follow to compliment therapy .read more

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