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How to Write a Physical Therapy Intake Form

Oct 13, 2022
(updated: Jan 27, 2023)
Max 5 min read

Physical therapy intake forms are a great way to ensure that all your patients receive the best possible care.

Physical therapy

While they may not seem important to your business, these documents can greatly impact how well patients follow through with their treatment plans and stay healthy in the long run.

What are physical therapy intake forms?

The physical therapy intake form is a document that provides information about the patient's current medical condition and history, as well as their goals for treatment. The form also collects information about the patient's family, occupation, and insurance coverage.

A physical therapy intake questionnaire helps your patients get the best possible care. The purpose of a PT intake form is to gather data about your patient and determine what kind of treatment they need based on their specific needs.

The information collected from this form will help guide your treatment plan and ensure that each patient receives individualized care tailored to their condition or injury.

Moreover, The form can also help the therapist determine whether their patient is a good fit for the practice or should be referred to another healthcare professional for treatment. The physical therapist usually fills out the PT intake form when a patient first visits the clinic.

In this form, the therapist will ask questions about the patient's medical history, current symptoms, and goals for treatment. The patient will then be asked to fill out an exercise log in which they document their progress.

physical therapy intake forms

Physical therapists also use these forms to track their patient's progress and ensure they follow through with their home program as prescribed.

The intake form may include questions about the following:

  • The patient's general health
  • The patient's medical history, including any allergies or medications they take
  • Their current symptoms, including pain levels
  • A list of their past injuries, surgeries, and hospitalizations
  • Their family history of disease or injury

Why do freelancers need software for intake forms?

As a physical therapist, you’re responsible for a patient's physical well-being. To ensure that you provide the best possible care, you need to know about their medical history and any other relevant information.

Usually, freelancing therapists avoid mentioning too many questions on the form as it makes the patient feel exhausted or uncomfortable. Still, they try to ask questions about the patient's past experiences with therapy or mental health services (if any).

It helps them determine what type of treatment plan would be best suited for their clients.

How do digital forms help freelancers?

Digital forms have been around for a while, and many industries these days opt for them. Unfortunately, physical therapy can become a long and frustrating process. But with the help of digital intake forms, it can become more efficient and less frustrating for the patient and the therapist.

physical therapy intake form

According to this survey, 81% of patients prefer digital forms over traditional paper and clipboards, with 83% saying they would rather complete forms online before coming into the healthcare facility.

Therefore, a digital physical therapy intake form is a new way for patients to get their initial evaluation and treatment.

A physical therapy intake form helps you:

Get the most out of your clients

If a client is unhappy with their treatment plan or progress, it's important that they feel as though their therapist has heard them. Hence, you must ask questions like "What do you think caused this problem?" and "How could I have helped?"

It would be best if you also were prepared to offer suggestions on how best to improve the situation, such as suggesting alternative exercises or giving relevant examples on the topic.

Ensure everything is correctly done

It includes ensuring all documentation is reviewed regularly and updated when necessary (e.g., if any new medications are in use).

Also, keep an eye out for any potential issues related directly to your patient; if something looks fishy here, it may indicate some malpractice claim could arise later down the road once things get worse instead of better!

Provide efficiency and convenience to the patients

It's not just about efficiency. It's about the comfort level for patients to be able to answer questions about pain, mobility, and symptoms without having to wait in long lines or cramped spaces.

Patients can fill out the form on their own time, and they can customize the form to fit their needs. Eventually, it helps decrease wait time at the clinic and provides a more efficient way of gathering information.

Easily access and transfer the data

Digital forms have been a boon for freelancers. They allow them to easily access and transfer the needed data without going through all the hassles of paper forms. The extracted data is transferred to the digital health record anytime, anywhere.

Furthermore, it prevents errors in data entry by up to 90% as the form has a built-in validation system that checks for errors before submission. 

How to craft your own physical therapy intake form

If you are a physical therapist and you want to create your intake form, here are a few things that you should keep in mind:

Try to keep it simple

The more information you include, the longer it will take for someone else to read and understand what you've written down.

If there is one key concept or point that sums up everything else on this page, make sure it's at the top of every page so readers know what they can expect from reading through all of your content.

Physical therapy intake form

Review your current intake packet

Consequently, the intake form is your first impression of a new patient. You should capture all the necessary information for your treatment plan and diagnosis. An intake form should be crafted and formatted in an easy-to-follow format.

This will help the patient to fill it out and provide accurate information. If any questions don't seem relevant or you think they could be better phrased, then change them.

Extract relevant information

One of the most important things physical therapists should remember when crafting their intake forms is to include all relevant information.

For example, it includes information about the patient's medical history, current injuries and pain, previous injuries or surgeries, and any past or current medications.

In addition, the physical therapy intake form should be designed in such a way that it can efficiently capture all this information. For instance, having contact information for the patient allows for follow-up if needed, and it also helps ensure that patients receive reminders about appointments or tests if they do not show up on time.

Thus, include all relevant patient information and additional screening tests (such as blood work). It will help ensure accuracy later on when submitting data into the system.

Mention your services

A brief description of your practice's unique focus or philosophy can be helpful, especially if you are trying to attract new patients with similar interests. Besides, if any service isn't covered within the insurance plan but might benefit some patients, then include this information.

However, ensure you don't go overboard with promoting these services because they will not help people access care.

What are the main elements of a physical therapy form?

In modern times, the development of online patient intake facilities has drastically simplified the information management process. Generally, the online patient intake forms make record-keeping neater and less redundant. If you are planning to craft a professional PT intake form, then don't forget to include these eight essential elements in your form!

Physical intake form

1. Patient's identifying information

A therapist first asks for the patient's identifying information, including their name, address, and phone number. This information is necessary for billing purposes and helps identify existing conditions that might need to be treated during a visit. Some therapists may also ask for other personal details such as age, height, and weight.

2. Always double-check insurance details

When you are a physical therapist and starting to work with a new patient, one of the first things you need to do is get their insurance details. This will help you know what kind of coverage they have and how much they have paid upfront.

This is important because different insurance plans have different rules about what services they will cover, how much the patient costs, and how often treatments can be given.

For example, some plans require that patients only go for physical therapy once every three months. This way, you won't waste time on patients who don't have insurance or who have insurance but don't cover physical therapy visits.

3. Referrals

Referral letters are one of the most important parts of a physical therapy intake form. A referral is an official letter or email from another healthcare provider to the therapist, which provides information about the patient's condition and treatment plan.

It is the process of sending patients to another doctor for treatment. It can be done by phone or in person. If the patient needs surgery, the referring physician sends the patient's medical records and X-rays to the surgeon before surgery.

4. Reason for visit and symptoms

In physical therapy, it is important to have a comprehensive intake form. For example, a Reason for Visit section can help the therapist understand the patient's main goal for a visit. It can also help the therapist to know what they should focus on during the session.

Likewise, a Symptoms section can help therapists identify specific pain points that may affect the patient's quality of life. These sections must be filled out accurately because they generate a plan of care for each patient.

5. Electronic signatures

Electronic Signatures are an essential element of physical therapy intake forms because they provide the form's authenticity and validity. It also helps in establishing the accountability and reliability of the form.


Electronic signatures are also ideal because they allow patients to sign forms without having to print them out, sign them, and scan them back in again! Moreover, they're HIPAA compliant and allow touchless patient check-in!

6. HIPAA Acknowledgement

The Health Insurance Portability and Accountability Act (HIPAA) is a law that the United States Congress enacted in 1996. A HIPAA Acknowledgement is a document that ensures the patient's privacy is protected by agreeing to the terms of a set of written disclosures.

In addition, HIPAA's goal is to protect health insurance coverage for workers who change or lose their jobs. It also protects individuals who have group health plans and their families, friends, and other dependents.

7. Consent forms

Consent forms are essential elements of physical therapy intake forms. They are the legal document that provides consent for treatment, and the patient signs it. The importance of a consent form cannot be underestimated, as it is a vital tool in the healthcare industry.

This form removes any ambiguity about what patients want and need to know before treatment can begin. It also helps to protect both the patient and therapist from legal action if something goes wrong.

8. Financial policy

Financial policy is one of the crucial elements of physical therapy intake forms. The intake form must include the financial policy section to inform patients about their financial obligations.

It should also include a payment statement, what fees will be charged, and whether the patient is responsible for any co-payments. The policy should also include a statement on how billing disputes are handled.


In this article, we've discussed the importance of creating professional PT intake forms for your clients. And while Indy doesn't have a physical therapy intake form template, you can easily create your own with our Forms builder tool by adding headlines, questionnaires, and other elements with drag-and-drop ease, and integrating forms right into your website.


The best part? You can easily save any template you create. No more painstakingly crafting one form at a time—try Indy today and save time, maximize efficiency, and grow your practice with help from Indy.

Save time, maximize efficiency, and grow your practice with help from Indy.

Get started today!

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