Ear, Nose and Throat Physicians of North MS PA
Practice Forms
 |
Consent for Treatment Who may have access to records, permission for other than parent to bring a minor child to the clinic |
 |
Assignment of Benefits assignment of insurance; non-certification of pre-certification or second opinion; financial responsibility; consent for release of PHI for treatment purpose |
 |
FALL RISK ASSESSMENT FES-I assessment score sheet filled out by the patient |
| |
EXERCISES: VRO (Eye Exercises) VOR exercises Sitting Exercises Take an item to read, hold it in front of you, move your head back and forth, up and down, around in circles both directions, as fast as you can and still be able to read the words on the page. Do each direction for abo |
| |
EXERCISES: CAWTHORNE-COOKSEY One of the first "general" interventions for vestibular problems were the Cawthorne-Cooksey exercises, as shown below. This is a one page handout of activities that progress from simple head movement to complex activities such as throwing a ball. SITTING |