David E. Kortmeyer, D.C.

Health is about feeling great!!!

QuickFacts

Address
David E. Kortmeyer, D.C.
34950 Date Palm Dr
Cathedral City, CA 92234

Hours

Contact

Phone: 760-321-1453

Fax: 760-324-6656

Thank you for filling out the online patient intake form.

These forms may be downloaded

	Description	Type & Size
Air Bag Injuries 19 Air Bag Injuries.pdf	Air Bag Injuries	pdf 0.21 MB
Auto Accident Intake Form 01 PT PI Intake Cus 1-10 New.pdf	Auto Accident Intake Form	pdf 1.51 MB
Body Pain Drawing 02 PT Pain Drawing Portrait.pdf	Body Pain Drawing	pdf 0.18 MB
Initial Health Status Patient Intake Form Initial health status intake.pdf	Patient Intake Form	pdf 0.22 MB
Keele STarT Back Screening Tool (ACN) 02 SBST.pdf	Please Fill Out. Thank You	pdf 0.11 MB
Neck Disability Index 14 Neck Disability Index.pdf	Neck Disability Index	pdf 0.12 MB
Nutrition Symptom Survey Form Symptom Survey Form Fillable.pdf	Nutrition Symptom Survey Form	pdf 1.35 MB
Oswestry Low Back Pain Scale 15 Oswestry Low Back Pain Scale.pdf	Oswestry Low Back Pain Scale	pdf 0.15 MB
Patient Intake Form Short Patient intake form.pdf	Patient Intake Form	pdf 0.33 MB
Patient Symptoms 04 PT Symptoms.pdf	Patient Symptoms	pdf 0.20 MB
Patient Symptoms with ADL 03 PT Patient symptoms form with ADL.pdf	Patient Symptoms with Activities of Daily Living	pdf 3.03 MB
QUADRUPLE VISUAL ANALOGUE SCALE 13 QVAS Form.pdf	QUADRUPLE VISUAL ANALOGUE SCALE	pdf 0.08 MB
UHC Form PS750 01 ACN PS750 Patient Summary Form.pdf	Please fill out patient section	pdf 0.22 MB
Work Injury Intake Form 1 of 2 WC Intake (1 of 2).pdf	Work Injury Intake Form 1 of 2	pdf 20.34 MB
Work Injury Intake Form 2 of 2 WC Intake (2 of 2).pdf	Work Injury Intake Form 2 of 2	pdf 10.97 MB