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.
Your 24 hours starts at your original surgery time given to us as we are on call from that time
forward. Rapid Recovery RX is not responsible for any medication taken without consent from
your surgeon or physician. Rapid Recovery RX is not responsible for the Airbnb rules or the rules
at the hotel you choose. Rapid Recovery RX is not responsible for any transportation that is not
agreed upon booking.