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PDFRecruitment : Physiotherapists

Your Details
Title
Surname *
First Name *
Address
Address
Town
County
Postcode
Daytime Telephone *
Evening Telephone
Mobile Telephone
Preferred contact number
Which number can we give out to clients if we need to?
Email *
Website
Date of Birth
Gender
Current Position
Membership of Professional Body
Membership No
Professional Indemnity Insurance
Certificate No
   
 Education/Training
Professional Qualifications:
Any Other Relevant Training:
Work Experience :
Other Relevant Experience:
Please indicate your clinical experience in dealing with the following
Whiplash - acute
Back Pain - acute
Soft Tissue injuries - other
Spinal Injuries
Traumatic Fractures
Structural deformities
Headaches/migraines
Arthritis
RSI
Carpal Tunnel Syndrom
Neuropathic pain
Amputees/phantom limb pain
Fibromyalgia
TMJ pain
Complex Regional Pain
Chronic Pain
Please add any other problems that you regularly treat in your work or areas of expertise:
Please rate your experience/expertise in the following treatment modalities:
Assessment of patient and pathologies - Subjective
Assessment of patient and pathologies - Objective
Manual therapies/mobilisation
Provision of exercise programmes
Electro-therapies
Acupuncture
Chronic Pain Management - psycho-education
Chronic Pain Management - Relaxation
Chronic Pain Management - Mindfulness
Chronic Pain Management - Sleep hygiene
Chronic Pain Management - Activity pacing/scheduling
Chronic Pain Management - Exposure
Chronic Pain Management - Medication management
The Pain Toolkit
The Pain Management Plan
Please add any other problems that you regularly treat in your work or areas of expertise:

We would be grateful if you could provide us with further information regarding your clinical skills and competences relevant to this post.

Please describe your experience in working in chronic pain management
Have you previously worked in an interdisciplinary chronic pain service?
Have you previously worked directly with a psychologist or psychotherapist?

If so, please describe briefly the nature of your work and role in the team.

What do you think are the key components to working with chronic pain?
What are the complications/risk factors that you would look out for working with this client group?
Please provide detai ls of your clinic room/s (please cont inue on separate
page i f necessary)
Name
Address
Post Code
Telephone
Email
Website
Onsite Parking
Disabled Access
   
What is your usual fee?
How long are your sessions?
Do you provide home visits? Assessment Therapy
Do you offer evening appointments? Assessment Therapy
What age of clients do you see? Children Adolescent Adult Elderly
How long is your waiting list?
How many days per week do you see private clients?
Please give details of your availability – ie days/session times.
Please provide details of two clinical referees
Name
Position
Address
Address
Postcode
Telephone
Email
   
Name
Position
Address
Address
Postcode
Telephone
Email
   
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