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Our Facility
Our Therapists
Services
Conditions
Patient Resources

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Home
Our Facility
Our Therapists
Services
Conditions
Patient Resources

Home
Our Facility
Our Therapists
Services
Conditions
Patient Resources

Home | Patient Resources

Patient Resources

Accepted Insurance

We offer flexible payment options with out-of-pocket fees and convenient pre-paid packages to suit your preferences.

We accept most other major medical insurance plans. We will however, accept out-of network benefits should your insurance carrier offer this benefit.

If you do not see your insurance company listed or are not sure if we accept you type of plan, please give us a call and we will be glad to take your information and verify your physical therapy benefits with us.

1199
Aetna
Anthem BCBS
AmeriHealth Health Plan
Blue Cross / Blue Shield
Cigna
Horizon BCBS

Medicare
Multiplan
NYF D/NYPD
No Fault
Oxford
United Healthcare
Worker’s Compensation

Tsahi (Zack) Niv, D.P.T., M.T.C

Aetna | #2298582

Oxford | #P2195022

BC/BS | #QA6161

Medicare | #QA6161

Anthem | #080013973NY01

United Healthcare | #2028059

Cigna | #IS4539068

New Patient Form

Enhance your experience with us by filling out the new patient form. Our team at Manhattan Sports & Manual Physical Therapy looks forward to getting to know you better and providing personalized care!

SEE NEW PATIENT FORM

Functional Assessment

Our spacious modern loft is conveniently located on 33rd Street, between Fifth and Madison Avenue. Our facility includes four comfortable and private treatment rooms equipped with the most advanced therapeutic equipment and modalities.

+ Back / Spine
+ Neck NDI
+ Shoulder / Arm / Hands
+ Knees / Legs / Hip
+ Fear Avoidance
+ Foot / Ankle

+ Back / Spine

OSWESTRY | Back/Spine

This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by checking ONE box in each section for the statement which best applies to you. We realise you may consider that two or more statements in any one section apply but please just shade out the spot that indicates the statement which most clearly describes your problem.

Name*

Pain Intensity*

0. I have no pain at the moment

1. The pain is very mild at the moment

2. The pain is moderate at the moment

3. The pain is fairly severe at the moment

4. The pain is very severe at the moment

5. The pain is the worst imaginable at the moment

Personal care (washing, dressing, etc.)*

0. I can look after myself normally without causing extra pain

1. I can look after myself normally but it causes extra pain

2. It is painful to look after myself and I am slow and careful

3. I need some help to manage most of my personal care

4. I need help everyday in most aspects of self-care

5. I do not get dressed - I wash with difficulty and stay in bed

Lifting*

0. I can lift heavy weights without extra pain

1. I can lift heavy weights but it causes extra pain

2. Pain prevents me from lifting heavy weights off the floor but I can mange if they are conveniently placed

3. Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned

4. I can lift very light weights

5. I cannot lift or carry anything at all

Walking*

0. Pain does not prevent me from walking any distance

1. Pain prevents me from walking more than 2 kilometres

2. Pain prevents me from walking more than 1 kilometre

3. Pain prevents me from walking more than 500 metres

4. I can only walk using a stick or crutches

5. I am in bed most of the time

Sitting*

0. I can sit in any chair as long as I like

1. I can only sit in my favourite chair as long as I like

2. Pain prevents me sitting more than one hour

3. Pain prevents me from sitting more than 30 minutes

4. Pain prevents me from sitting more than 10 minutes

5. Pain prevents me from sitting at all

Sex life (if applicable)*

0. My sex life is normal and causes no extra pain

1. My sex life is normal but causes some extra pain

2. My sex life is nearly normal but is very painful

3. My sex life is severely restricted by pain

4. My sex life is nearly absent because of pain

5. Pain prevents any sex life at all

Standing*

0. I can stand as long as I want without extra pain

1. I can stand as long as I want but it gives me extra pain

2. Pain prevents me from standing for more than 1 hour

3. Pain prevents me from standing for more than 30 minutes

4. Pain prevents me from standing for more than 10 minutes

5. Pain prevents me from standing at all

Social Life*

0.My social life is normal and gives me no extra pain

1. My social life is normal but increases the degree of pain

2. Pain has no significant effect on my social life apart from limiting my more energetic interests eg: sport

3. Pain has restricted my social life and I do not go out as often

4. Pain has restricted my social life to my home

5. I have no social life because of pain

Sleep*

0. My sleep is never disturbed by pain

1. My sleep is occasionally disturbed by pain

2. Because of pain I have less than 6 hours sleep

3. Because of pain I have less than 4 hours sleep

4. Because of pain I have less than 2 hours sleep

5. Pain prevents me from sleeping at all

Travelling*

0. I can travel anywhere without pain

1. I can travel anywhere but it gives me extra pain

2. Pain is bad but I manage journeys over two hours

3. Pain restricts me to journeys of less than one hour

4. Pain restricts me to short necessary journeys under 30 minutes

5. Pain prevents me from travelling except to receive treatment

+ Neck NDI

Neck Disability Index | Neck / TMJ / Headaches

This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the one box that applies to you. We realise you may consider that two or more statements in any one section relate to you, but please just mark the box that most closely describes your problem.

Name*

Pain Intensity*

0. I have no pain at the moment

1. The pain is very mild at the moment

2. The pain is moderate at the moment

3. The pain is fairly severe at the moment

4. The pain is very severe at the moment

5. The pain is the worst imaginable at the moment

Personal care (washing, dressing, etc.)*

0. I can look after myself normally without causing extra pain

1. I can look after myself normally but it causes extra pain

2. It is painful to look after myself and I am slow and careful

3. I need some help to manage most of my personal care

4. I need help everyday in most aspects of self-care

5. I do not get dressed - I wash with difficulty and stay in bed

Lifting*

0. I can lift heavy weights without extra pain

1. I can lift heavy weights but it causes extra pain

2. Pain prevents me from lifting heavy weights off the floor but I can mange if they are conveniently placed

3. Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned

4. I can lift very light weights

5. I cannot lift or carry anything at all

Reading*

0. I can read as much as I want to with no pain in my neck

1. I can read as much as I want to with slight pain in my neck

2. I can read as much as I want with moderate pain in my neck

3. I can’t read as much as I want because of moderate pain in my neck

4. I can hardly read at all because of severe pain in my neck

5. I cannot read at all

Headaches*

0. I have no headaches at all

1. I have slight headaches which come infrequently

2. I have moderate headaches which come infrequently

3. I have moderate headaches which come frequently

4. I have severe headaches which come frequently

5. I have headaches almost all the time

Concentration*

0. I can concentrate fully when I want to with no difficulty

1. I can concentrate fully when I want to with slight difficulty

2. I have a fair degree of difficulty in concentrating when I want to

3. I have a lot of difficulty in concentrating when I want to

4. I have a great deal of difficulty in concentrating when I want to

5. I cannot concentrate at all

+ Shoulder / Arm / Hands

DASH | Shoulder / Arm / Hands

Please rate your ability to do the following activities in the last week by checking the number below the appropriate response.

Name*

Open a tight or a new jar*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Write*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Turn a key*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Prepare a meal*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Push open a heavy door*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Place an object on a shelf above your head*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Do heavy household chorse (i.e wash walls, wash floors, etc.)*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Garden or do yard work*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Make a bed*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Carry a shopping bag or briefcase*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Carry heavy object (over 10lbs)*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Change a lightbulb overhead*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Wash or blow-dry hair*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Wash your back*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Put on a pullover sweater*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Use a knife to cut food*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Recreational activities that require little effort (i.e cardplaying, knitting)*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Recreational activities that require some force or impact through your arm, shoulder or hand*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Recreational activities in which you move your arm freely (i.e frisbee, badminton, interpretive dance)*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Manage transportation needs (getting from one place to another)*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

Sexual activities*

0. No difficulty

1. Mild Difficulty

2. Moderate Difficulty

3. Severe Difficulty

4. Unable to perform

+ Knees / Legs / Hip

LEFS | Knees / Legs / Hip

We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity. Today, do you or would you have any difficulty at all with.

Name*

Any of your usual work or school activities*