QuickDash Form

This questionnaire asks about your symptoms as well as your ability to perform certain activities. Please answer every question, based on your condition in the last week, by selecting the appropriate number. If you did not have the opportunity to perform an activity in the past week, please make your best estimate of which response would be the most accurate. It doesn't matter which hand or arm you use to perform the activity; please answer based on your ability regardless of how you perform the task.
Please rate your ability to do the following activities in the last week by selecting the number below the appropriate response:
Please rate your ability to do the following activities in the last week by selecting the number below the appropriate response:
Please rate your ability to do the following activities in the last week by selecting the number below the appropriate response:
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Optimal Physical Therapy

Phone: 307.333.2873

Fax: 307.333.4034

Address: 4120 South Poplar Street Casper, WY 82601

Optimal Pediatric Therapy

Phone: 307.333.6200

Fax: 307.333.5880

Address: 4270 South Poplar Casper, WY 82601

Optimal Speech and Language

Phone: 307.333.2873

Fax: 307.333.4034

Address: 4120 South Poplar Street Casper, WY 82601

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