--- title: Limb Difference & Congenital Disability Therapy Intake Form Template | Paperform description: A compassionate, comprehensive therapy intake form for clients with limb differences or congenital disabilities. Covers medical history, adaptive equipment, social experiences, and therapeutic goals. url: "https://paperform.co/templates/limb-difference-congenital-disability-therapy-intake-form" type: static generatedAt: "2026-04-03T00:49:22.340Z" --- [← Back to free form templates](/templates/) ![Limb Difference & Congenital Disability Therapy Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/limb-difference-congenital-disability-therapy-intake-form.png) [Preview](https://_preview.paperform.co/ai-template/limb-difference-congenital-disability-therapy-intake-form) [Use this template for free](/create?ai-template=limb-difference-congenital-disability-therapy-intake-form) [Intake Forms](/templates/category/intake-forms/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/) [Therapist](/templates/role/therapist/)[Counselor](/templates/role/counselor/)[Psychologist](/templates/role/psychologist/)[Social Worker](/templates/role/social-worker/) About this free form template 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. Built for growing businesses, trusted by bigger ones. Trusted by 500K+ business owners and creators, and hundreds of millions of respondents. ![Capterra - 4.8 out of 5](/images/capterra-st.jpg) ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg) ![G2 - 4.8 out of 5](/images/g2-st.jpg) [Try Paperform free now](/register) ## More templates like this [![Acceptance and Commitment Therapy (ACT) Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/acceptance-and-commitment-therapy-act-intake-form.png) ### Acceptance and Commitment Therapy (ACT) Intake Form Comprehensive ACT therapy intake form with psychological flexibility assessment, values clarification exercises, and committed action planning to help therapists understand client needs and therapeutic goals.](/templates/acceptance-and-commitment-therapy-act-intake-form/) [![Addiction Recovery Therapy Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/addiction-recovery-therapy-intake-form.png) ### Addiction Recovery Therapy Intake Form A comprehensive intake form for addiction recovery counselors to gather essential information about new clients, including substance use history, previous sobriety attempts, support network, and recovery goals.](/templates/addiction-recovery-therapy-intake-form/) [![Borderline Personality Disorder Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/borderline-personality-disorder-assessment-form.png) ### Borderline Personality Disorder Assessment Form A comprehensive clinical assessment tool for screening borderline personality disorder symptoms, including emotion dysregulation, relationship patterns, and behavioral indicators.](/templates/borderline-personality-disorder-assessment-form/) [![Burn Survivor Counseling Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/burn-survivor-counseling-intake-form.png) ### Burn Survivor Counseling Intake Form A compassionate intake form for burn survivors seeking mental health support, covering injury details, physical recovery, emotional challenges, and treatment goals.](/templates/burn-survivor-counseling-intake-form/) [![Child & Adolescent Mental Health Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/child-adolescent-mental-health-intake-form.png) ### Child & Adolescent Mental Health Intake Form A comprehensive mental health intake form for children and adolescents, collecting developmental history, school performance, family dynamics, and behavioral concerns to support effective treatment planning.](/templates/child-adolescent-mental-health-intake-form/) [![Chronic Nausea & Hyperemesis Mental Health Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/chronic-nausea-hyperemesis-mental-health-intake-form.png) ### Chronic Nausea & Hyperemesis Mental Health Intake Form A specialized mental health intake form for patients experiencing chronic nausea and hyperemesis, assessing symptom severity, nutritional status, medical history, and quality of life impact.](/templates/chronic-nausea-hyperemesis-mental-health-intake-form/) [![Cognitive Behavioral Therapy Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/cognitive-behavioral-therapy-intake-form.png) ### Cognitive Behavioral Therapy Intake Form A comprehensive CBT intake form with depression screening, anxiety assessment, and therapy goals to help mental health professionals understand new clients and establish treatment plans.](/templates/cognitive-behavioral-therapy-intake-form/) [![Combat Stress Reaction Therapy Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/combat-stress-reaction-therapy-intake-form.png) ### Combat Stress Reaction Therapy Intake Form A specialized intake form for mental health professionals working with military personnel experiencing combat stress reactions. 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