Patient Physical Therapy Intake Form

About this form

This form captures essential information to support assessment, treatment planning, and ongoing care. It records patient demographics, medical history updates, presenting complaints, injury onset, diagnostic test results, previous treatments, prior functional status, therapy goals, pain characteristics, functional limitations, and relevant medical conditions. The form also includes appointment reminder preferences, acknowledgement of cancellation policies, and informed consent for physical therapy services, ensuring key administrative and clinical information is documented in one place. By organising intake information into a structured record, Heidi helps clinicians complete documentation more efficiently, support informed treatment planning, and focus on delivering personalised rehabilitation and patient care.

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