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Forms & Surveys

Below is a set of Online Forms which need to be completed by patients coming for treatment at Shamim Khan Physiotherapy Centre:

Patient Forms

Patient Health Declaration Form-COVID-19*** Required to be completed by every patient prior to commencement of outpatient Physiotherapy treatment at SHAMIM KHAN PHYSIOTHERAPIST
Dry Needling Treatment Form 
Withdrawal Of Dry Needling Form 


Help us to improve our level of service by completing the surveys below:

Patient Satisfaction Survey  Tell us about your overall experience at Shamim Khan Physiotherapy