12-Week Program Template for Rehabilitation & Corrective Exercise

Use in FirstRep document

Client Intake Information

Gathering essential information to tailor the program to each client's needs.

Aa Client Name *

Enter client's full name

... Injury History *

Describe past injuries and surgeries

1-10 Current Pain Level *

Rate from 1 (no pain) to 10 (worst pain)

D Physical Therapy Clearance Date *

Select date of PT clearance

Goals and Objectives

Setting realistic goals to track progress and motivate clients.

... Short-term Goals *

List goals for the next 4 weeks

... Long-term Goals *

List goals for the next 12 weeks

Exercise Selection

Choosing appropriate exercises that align with client's abilities and rehabilitation needs.

v Exercise Type *

Select exercise type

... Exercise Description *

Provide details on the exercise

Aa Sets and Reps *

Enter sets and repetitions (e.g., 3x10)

... Progression Plan *

Outline how to progress this exercise

Weekly Progress Tracking

Documenting progress and adjustments to ensure client stays on track.

# Week Number *

Enter week number (1-12)

... Progress Notes *

Document any changes in pain or performance

... Adjustments Made *

List any adjustments to the program

Client Feedback

Collecting feedback to improve the program and address concerns.

1-10 Satisfaction Rating *

Rate satisfaction from 1 to 10

... Comments

Provide any additional comments or concerns

Why Use This Template

Structured Rehabilitation

Provides a clear framework to support clients' recovery process.

Goal-Oriented Approach

Helps clients stay focused and motivated throughout their rehabilitation journey.

How to Use

Complete the client intake information to understand their specific needs.

Set achievable short-term and long-term goals with your client.

Customization Tips

Adjust exercise selections based on individual client capabilities.
Incorporate client feedback to adapt goals and objectives.
Ensure to follow up with healthcare providers for progress updates.

Build and send rehabilitation & corrective exercise templates digitally with FirstRep. Free for up to 3 clients.

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Frequently Asked Questions

What if my client experiences pain during exercises?

Always prioritize safety. Modify the exercise or consult the client's healthcare provider for guidance.

How do I communicate with the client's physical therapist?

Establish an open line of communication to discuss the client's progress and any adjustments needed.