• Injury Rehabilitation Progress Report Form

    Use this form to document a patient’s rehabilitation progress, current status, functional abilities, concerns, and next steps for an injury recovery plan.

  • Patient and Case Information

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Report Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Injury Date / Date of Onset
     - -
    2 digit month, 2 digit day, 4 digit year

  • Current Rehabilitation Status

  • Attendance/compliance with prescribed exercises*

  • Functional Abilities and Daily Activities

  • Ability to Perform Daily Activities*
  • Ability to Perform Work, School, or Sport Tasks*
  • Movement Limitations
  • Self-Care Independence*

  • Complications, Concerns, and Next Steps

  • Adverse Reactions to Therapy or Exercises
  • Missed Sessions or Barriers to Rehabilitation
  • Date of Next Review*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty:
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