WE HATE SPAM BUT l e TO HELP SUBSCRIBE! EXPERIENCE THE D ere • 25+ locations owned & operated by PTs • Open M-F 6am - 8pm & Sat 8am - Noon • Guaranteed 24-48 hour evaluation • Individualized treatment plans • Hands-on/one-on-one therapy • Functional movement specialists CONNECT WITH US Facebook “ f ” Logo CMYK / .ai Facebook “ f ” Logo CMYK / .ai Unilateral Vestibular Hypofunction Bilateral Vestibular Hypofunction Fall Risk/Decreased Balance Cervicogenic Dizziness Therapeutic Exercise Strengthening HEP Neuromuscular Re-education Repositional Exercises Habituation Exercises Substitution Exercises Balance Training Gait Training Therapeutic Activity _______________________________________________________________________________________ _______________________________________________________________________________________ Dates To Cover:_______________________________________ to______________________________________ Physician Signature__________________________________________________________Date:______________ Patient’s Name:_________________________________________DOB:___________________ Evaluate and Treat as Indicated VESTIBULAR PHYSICAL THERAPY RX 11/2012 Duration: _______1 wk. _____ 2wks. _______3wks. _______4wks. ___________________________________ other Frequency: _______ Daily _______ 2 x wk. _______ 3 x wk. _______ 4 x wk. Acct. Number:_____________________________________ Difficulty Walking Vertigo BPPV Other______________________________________________________ DIAGNOSIS TREATMENT SPECIAL INSTRUCTIONS Other__________________________________________________________________________ PHYSICAL THERAPY AND MEDICAL FITNESS See reverse side for maps Rochester Hills 878 S. Rochester Rd. Rochester Hills, MI 48307 (248) 650-4404 Fax: (248) 650-4757 Clinton Twp. 21550 Harrington, Ste D. Clinton Twp., MI 48036 (586) 783-7590 Fax: (586) 783-7876 Lake Orion 3009 Baldwin Rd. Orion Twp., MI 48359 (248) 393-7707 Fax: (248) 393-7708 Oxford 53 S. Washington St. Oxford, MI 48371 (248) 236-0035 Fax: (248) 236-0125 Shelby Twp. 48875 Hayes Rd. Shelby Twp., MI 48315 (586) 532-9602 Fax: (586) 532-9605 Romeo 67962 VanDyke Romeo, MI 48065 (586) 336-4022 Fax: (586) 336-4082 Clawson/Troy 901 W. Maple Rd. Clawson, MI 48017 (248) 435-8230 Fax: (248) 435-8270 Macomb Twp. 23211 21 Mile Rd. Macomb Twp., 48042 (586) 231-0043 Fax: (586) 741-8953 Clarkston 32 S. Main St. Clarkston, MI 48346 (248) 922-9001 Fax: (248) 922-9020 Hours Mon-Fri 6am-8pm Saturday 8am-Noon TOLL FREE: (855) 477-8463 9 CONVENIENT Most Insurances Immediate Sc PHYSICAL THERAPY AND Rochester Hills Lake Orion Oxford Clawson/Troy Clarkston MACOMB CO Romeo Shelby Township Clinton Township Macomb Township 24 59 Oxford Downtown B W. Maple Road Avon R Lake Orion Clawson Clarkston Waldon Road Ortonville Rd. Rochester Rd. Livernois Baldwin 15 Rochester 75 75 75 OAKLAND C Call us Toll Free @ ( ...and get our monthly tips (we promise never to send more!)
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