PROGRESS EVALUATION II

Patient Progress Evaluation – 5 Essentials & Programs

Patient Name *

Date

Overall Improvement

Rate patient's understanding of each essential (1–10):

Is patient following the care plan?

Yes

No

Is patient doing home exercises?

Yes

No

Is patient attending workshops/classes?

Yes

No

Programs enrolled in

Program progress notes

Toxin reduction notes

Additional Notes

Patient Signature *

Sign here with your finger or stylus

Provider/Doctor Signature

Sign here with your finger or stylus