Medella Collective is a faith-based physical therapy clinic located in Weatherford, Texas. The clinic works to improve overall health, well-being, and comfort for its patients through personalized care. Medella offers a range of treatment services, including orthopedic physical therapy, sports rehabilitation, chronic pain treatment, and acupuncture. As the clinic continues to prioritize the patient experience, Medella sought ways to improve its care. To find ways to meet Medella’s needs, I interviewed several business owners and workers in similar fields. From these interviews, I concluded that a simple form would allow the clinic to identify common concerns as well as build upon its areas of success. This capstone supports Medella’s goal by giving a professional, one-page, and easy-to-complete form for patients. The form is the first step towards improving the overall experience as Medella continues to build its image in the Weatherford community.