Exercise Log Medical Form

Exercise 1
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 2
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 3
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 4
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 5
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 6
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 7
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 8
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 9
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Sets/Reps /
Weight used/Theraband • • •
Therapist Intervention
Exercise 10
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 11
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 12
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 13
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 14
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 15
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 16
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 17
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 18
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 19
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Exercise 20
Name of Exercise
Patient Participation • • •
Patient Position • • •
Resistance • • •
Weight used/Theraband • • •
Sets/Reps /
Therapist Intervention
Impact of Exercise(s) on Functional Performance/Patient Response to Treatment

Physical Therapist

Dr Cristina Olteanu - Exercise Log

There are 22 copies in use.
Published: Feb. 24, 2017, 6:57 p.m.
Doctor: Dr. History Physical
Rating: +1 /

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Exercise Log Medical Form

Physical Therapist

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