and the world is flat ppt on the left at 65 degrees by tight hamstrings. You can also see. Chief Complaint: Pain in the right buttock, extending down the right lateral thigh and into the foot. Impression: This patient has a long history of right buttock, right low back, and right lower extremity pain that worsens as her day progresses. Previous Therapy: This patient has received physical therapy for a few sessions in the past for treatment of low back pain. Download, physical Therapy Evaluation Example m, this is a good evaluation that can be used by therapists and it lists plenty of information, including if you have applied earlier, how you heard about the company and more. Download, physical Therapy Evaluation Form m, this is an initial evaluation form that you should fill out before you start therapy and it includes all of the pertinent details. It will also allow them to see how far you have come during therapy and determine when you are done.