Limb Difference & Congenital Disability Therapy Intake Form

Supporting clients with limb differences or congenital disabilities requires a thoughtful, person-centered approach that honors the full scope of their lived experience. This Limb Difference & Congenital Disability Therapy Intake Form is designed for therapists, counselors, and mental health professionals who work with individuals navigating identity, self-acceptance, accessibility, and social dynamics related to physical difference.

This intake template covers essential areas including medical and developmental history, current adaptive equipment use, mobility considerations, social and emotional wellbeing, and therapeutic goals. It creates space for clients to share their own perspective on their body, their support systems, and the challenges or strengths they bring into the therapeutic relationship.

Built with Paperform, this intake form is fully customizable to reflect your practice's tone and approach. You can adjust conditional logic to tailor follow-up questions, embed the form on your website, and use the doc-style editor to add empathy-driven language, images, or video introductions that help clients feel seen before they even arrive.

Once submitted, responses can automatically route to your practice management system, trigger a welcome email, or—using Stepper—kick off an onboarding workflow that books the first session, sends intake summaries to your EHR, and notifies your admin team. If informed consent or HIPAA-compliant documentation is part of your workflow, you can use Papersign to collect eSignatures on consent forms immediately after intake.

Whether you're a solo practitioner, part of a multidisciplinary clinic, or working in pediatric or adult rehabilitation settings, this template helps you start the therapeutic relationship with clarity, respect, and care. Trusted by mental health professionals for secure, client-centered intake, Paperform is SOC 2 Type II compliant and offers the flexibility to meet clients where they are—on any device, in any format.