PINC Cancer Rehab

Pre-Screen Questionnaire


Please complete the following before attending your PINC Cancer Rehab Assessment:


I have answered these questions to the best of my belief and will update the Physiotherapist of any changes in my health, or if I become pregnant.

I understand that my failure to do so, may post a threat to my health and or my physical well being and I hold Sussex Physio Pilates and my Physiotherapist, from any liability whatsoever, arising from failure on my part.

By my electronic submission below, I agree to this policy and client agreement. 

This information is protected by the Data Protection Act 1998

Please view our Privacy Policy HERE