Bio Questionnaire - Mountain Land Physical Therapy

Full Name

Credentials (example: PT, DPT)

Title(s) (example: "Physical Therapist", "Clinic Director, Physical Therapist", etc.)

Clinic Location(s) (example: "Cottonwood", "West Jordan RPT"). If you are going to be treating in multiple clinics make sure to list all of them.

Email

Cell Phone for Cards (Optional)

Shirt Size

When is your projected start date?

How long have you been with Mountain Land? (If applicable)

How long have you practiced therapy? (If applicable)

Where did you go to school and when did you graduate?

What is your degree?

Do you have additional training?

What are your specializations or areas of expertise? What makes you special as a therapist?

What is your therapy “philosophy” (what is your approach to treating patients)?

What continuing education credits do you have?

What inspired you to enter this field?

What are your interests and hobbies?

Which of the following services are you qualified to treat?

Do you have any Board Certifications?

Which Board Certifications do you have?

Additional notes