Brain Injury Therapy Intake Form

Brain Injury Therapy Intake Form Template

Working with brain injury patients requires detailed understanding of their injury history, cognitive changes, and ongoing challenges. This brain injury therapy intake form is designed for mental health professionals, neuropsychologists, occupational therapists, and rehabilitation specialists who need comprehensive patient information before beginning treatment.

Why This Form Matters for Brain Injury Therapy

Brain injuries—whether traumatic (TBI) or acquired (ABI)—affect each patient differently. Understanding the mechanism of injury, timeline, cognitive and personality changes, and current symptoms helps therapists create individualized treatment plans that address the whole person, not just isolated symptoms.

This template captures:

• Injury mechanism and timeline to understand severity and context
• Cognitive changes including memory, attention, executive function, and processing speed
• Personality and behavioral shifts that affect relationships and daily life
• Current symptoms across physical, emotional, and cognitive domains
• Rehabilitation history to build on previous progress and avoid duplication
• Support systems and daily functioning levels to inform realistic goals

Perfect for Mental Health and Rehabilitation Professionals

This intake form is ideal for:

• Clinical psychologists and neuropsychologists specializing in brain injury
• Licensed therapists (LCSW, LPC, LMFT) working with TBI/ABI patients
• Occupational therapists focused on cognitive rehabilitation
• Speech-language pathologists addressing cognitive-communication disorders
• Rehabilitation counselors coordinating multidisciplinary care
• Behavioral health specialists in hospital and outpatient settings

Streamline Your Practice with Paperform

Built on Paperform, this template offers a compassionate, user-friendly experience for patients and families during a vulnerable time. The clean layout and logical flow make it easy to complete, while conditional logic ensures you only ask relevant follow-up questions based on their specific situation.

Need to collect signatures on consent forms? Integrate Papersign to handle treatment authorizations and HIPAA releases seamlessly. Want to automate follow-up workflows? Use Stepper to trigger appointment reminders, send onboarding materials, or notify your team when high-priority cases come in.

Paperform's secure, professional platform helps mental health and rehabilitation professionals spend less time on paperwork and more time providing the specialized care brain injury patients deserve.