Weekly Check-In Template for Rehabilitation & Corrective Exercise Coaches

Use in FirstRep form

Client Information

Gather essential details about the client to tailor their rehabilitation plan.

Aa Client Name *

Enter client's full name

# Age *

Enter client's age

... Injury/Surgery Details *

Describe the injury/surgery and date

Current Pain Level

Assess the client's pain level to track progress.

1-10 Pain Level (1-10) *

Rate your pain level

Aa Pain Location *

Specify the pain location

Progress Assessment

Evaluate the client's progress toward their rehabilitation goals.

... Goals Achieved

List goals achieved this week

... Challenges Faced

Describe any challenges faced

* Satisfaction with Progress *

Rate satisfaction (1-5)

Exercise Feedback

Document the client's feedback on exercises performed.

... Exercises Performed *

List exercises done this week

Aa Exercise Difficulty

Rate the difficulty of exercises

Y/N Pain During Exercise *

Did you experience pain during exercise?

Next Steps

Outline the next steps for the client’s rehabilitation.

... Recommended Exercises *

List exercises for next week

... Adjustments Needed

Specify any adjustments to the plan

D Follow-Up Appointment Date *

Schedule next appointment

Why Use This Template

Enhances Communication

Facilitates better communication between coaches and clients about pain and progress.

Tracks Progress

Helps in tracking the client's recovery journey effectively.

How to Use

Have your client fill out the form at the end of each week.

Review the feedback to adjust their exercise plan as necessary.

Customization Tips

Adjust the pain level scale to fit specific client needs.
Add personalized notes sections for each client.
Incorporate visual aids for exercises tailored to client capabilities.

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

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Frequently Asked Questions

How often should clients fill out the check-in?

Clients should complete the check-in weekly to monitor their progress effectively.

What if a client reports increased pain?

If increased pain is reported, adjust the exercise plan and consult with their healthcare provider.