INFORMED CONSENT

I understand that I am receiving physical therapy from LIC Strong PT, which is comprised of Dmitry Choklin, PT, DPT or his contractor clinicians for an initial evaluation and/or treatment. This may consist of having any or all of the following: Reviewing my past medical history, a movement assessment, various objective tests & measures such as range of motion and strength, manual therapy, education regarding my plan of care and therapeutic exercise prescription. My physical therapist has informed me of any potential risks, advantages and alternative options I have for treatment. I can stop evaluation and treatment at any time and am freely able to ask my physical therapist questions at any time during the evaluation/treatment session.

    Contact Info

    Dmitry R. Choklin
    PT, DPT, CSCS, CKTP

    Cell: (917) 328-8098
    Fax: (866) 282-1162
    Email: dchoklin@yahoo.com

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