Prohab Studio Treatment Plan

Client Name *

First

Last *

Last

Email *

Condition ID

e.g. Regime number, injury condition

Todays Date *

The purpose of the programme is to enable a return to - *

more detail

Expected recovery based on best estimate (% of preinjury capacity)

(% of preinjury capacity)

Time to expected recovery based on best estimate

Relevant rehab considerations

e.g. Medical alerts, barriers to rehab, etc.

consideration

Programme structure & content

type of Prohab programme

Custom Programme

Week 1&2

Custom Programme

Week 3&4

Custom Programme

Week 5&6

Programme Designer

who built the programme

Studio Session Supervisor Studio Session Supervisor

Who will deliver the programme in the studio

Studio Session Frequency

Studio Session Supervision Level

Programme Review Timeline

Includes – subjective & objective testing, then replanning.

Suggested Payment Plan

$ amount

General Comments

If you are human, leave this field blank.