Physical therapy intake forms for injury and function
A physical therapy intake packet collects referral and referring-provider details, injury or surgery dates, pain and function information, affected daily activities and the patient's goals. Registration, prior therapy, consent and financial policy complete the first-visit paperwork.
The clinical lead chooses any functional outcome questionnaire and confirms its licence with the owner. Intake Pro keeps the questionnaire's total with the signed response.
Last updated
- Typical forms 7
- History Injury and prior care
- Function Activities and goals
- Questionnaires Licence checked by practice
- Scoring Kept with response
- Delivery Link or check-in kiosk
What goes in a physical therapy intake packet?
A physical therapy intake packet combines administrative details with a focused account of the injury, current function and treatment goals. Referral information and functional questionnaires can be separate forms so staff assign them only when needed.
| Form | What it collects | Signature |
|---|---|---|
| Patient registration | Identity, contact details, emergency contact and insurer information | Patient or authorized representative |
| Referral and care history | Referral source, referring provider, diagnosis given to patient and prior therapy | Usually no separate signature under office policy |
| Injury, pain and function history | Injury or surgery date, symptoms, activity limits and patient goals | Confirmation if the practice requires it |
| Functional outcome questionnaire | Clinical-lead-selected items and scored responses | Set by the questionnaire procedure |
| Consent to treatment | The practice's counsel-approved evaluation and treatment consent | Patient or authorized representative |
| Financial policy | Payment responsibility, insurance balances and cancellation terms | Patient or responsible party |
| Privacy notice acknowledgment | Receipt of the practice's notice of privacy practices | Patient or personal representative |
What does a physical therapy history form ask?
A physical therapy history form connects the referral and event history to what the patient can do now. The answers give the therapist a concise starting point without turning the intake packet into a clinical assessment by front-desk staff.
- Referral source and referring provider, including contact details and any referral document the practice's workflow uses.
- Injury or surgery date, how the problem began and any relevant operation or hospital care.
- Pain location and intensity, using the practice's chosen rating field and space for the patient's description.
- Function questions covering movement, tolerance and tasks that have changed since the injury or surgery.
- Daily activities affected at home, work, school, recreation or sport, with follow-ups only for relevant areas.
- Patient goals written in practical terms, such as an activity the patient wants to resume.
- Prior therapy for this or a related concern, including approximate dates, provider and the patient's account of the outcome.
Which physical therapy forms require signatures or review?
Physical therapy treatment consent, financial terms and the privacy acknowledgment should remain identifiable as separate agreements. Counsel can review their wording, while the practice manager assigns signatures and record-handling responsibilities.
Under 45 CFR 164.520(c)(2), a provider with a direct treatment relationship gives the privacy notice by the first service date and, except in an emergency, makes a good-faith effort to get written acknowledgment. If that effort fails, the provider documents its efforts and the reason.
Ask your state board and counsel about referral and direct-access requirements for your practice. Have counsel review consent and financial terms, and have the clinical lead approve all pain, function and questionnaire wording before staff publish it.
This legal information is general. Confirm your physical therapy practice's notice, consent, referral and direct-access process with its state board as appropriate and its own counsel or compliance lead.
How do physical therapy practices use outcome questionnaires?
Physical therapy practices use functional outcome questionnaires chosen by the clinical lead. Many are copyrighted, so the practice must confirm the licence with each questionnaire's owner before reproducing or building it online.
Once the practice has the necessary permission and approved wording, staff can build the questionnaire with scored assessments. Item weights, reverse-scored items, subscales and labelled score bands are available, and the total stays with the signed response.
The clinical lead should verify the configured items and scoring against the owner's materials before publication. Keep the questionnaire as its own form when it applies to a particular body region, visit or patient group, rather than adding every questionnaire to every packet.
How do you set up physical therapy intake online?
Set up physical therapy intake online with your existing approved documents, a focused function history and only the questionnaires assigned by the clinical lead. Test referral and representative paths before sending the packet.
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Recreate your forms
Upload existing PDF or Word files for conversion, or build the approved text and fields directly in the form builder.
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Add conditional details
Show surgery fields after a surgery answer, repeating prior-care rows and signature fields on treatment consent and financial policy.
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Build chosen scoring
After confirming each licence, create the selected questionnaire with approved item weights and have the clinical lead check its totals.
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Group and publish
Arrange core forms in intake packets, test the patient path on a phone and publish the reviewed versions.
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Send or open at check-in
Text or email a private link before the visit, or let the patient finish outstanding forms on the paired office kiosk.
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Find signed responses
Open the packet PDF, signed versions, questionnaire totals and audit trail, then download the records staff need to file.
When should physical therapy patients complete intake?
Physical therapy patients should complete intake before the first visit so the therapist can review the injury story, functional limits and goals. Staff should leave a kiosk route for patients who need help finishing.
The front-desk lead checks referral details, injury or surgery dates, consent and policy signatures, and whether the assigned questionnaire has a response. Staff direct clinical questions to the therapist and file downloaded signed PDFs through the practice's chart process.
Review shared fields in the intake forms guide and signature assignments in patient intake forms. For a related injury workflow, see chiropractic intake forms.
Questions
What referral details belong in physical therapy intake?
Collect the referral source, referring provider and the contact or document details your front desk uses. Check referral and direct-access requirements with your state board and counsel for your own practice.
Can a physical therapy questionnaire be scored online?
Yes, after the practice confirms permission and approved wording with the owner. Intake Pro supports item weights, reverse-scored items, subscales and labelled bands, with the total retained beside the response.
Who chooses a physical therapy functional outcome questionnaire?
The clinical lead chooses the questionnaire and its review process. The practice confirms licensing with the owner, then builds and tests the approved version before assigning it to patients.
How do physical therapy goals differ from administrative intake?
Goals describe the activities or changes the patient wants to work toward, while administrative intake records identity, contact, insurance and policy details. Separate sections help staff and therapists find the answers they need.