Client Assessment Form
Please answer the questions on this form so your recovery care provider can take care of you safely.These questions are about your medical history, and health concerns. Please do your best to answer all of the questions. This form is a confidential medical record. Only information directly related to your health and safety while in the care of Rapid Recovery RX team and transportation service may be given to your surgeon/ facility, or emergency hospital if admitted. Personal health information will not be given to anyone without your consent. Please sign and date form.
1
2
3