Streamline Your Lymphedema Therapy Patient Intake

This Lymphedema Therapy Intake Form is designed specifically for physical therapy clinics, occupational therapy practices, and lymphedema specialists who need to gather comprehensive patient information before beginning treatment. Managing lymphedema requires detailed baseline measurements, thorough medical history, and ongoing tracking—and this template helps you capture all the essential details in one organized, professional form.

Whether you're seeing post-mastectomy patients, cancer survivors, or individuals with primary lymphedema, this intake form ensures you collect critical information about swelling measurements, cancer treatment history, compression garment compliance, and previous infection episodes. The structured format helps you establish accurate baseline data for treatment planning and insurance documentation.

Built for lymphedema therapy professionals including:

• Certified Lymphedema Therapists (CLTs)
• Physical therapists specializing in lymphedema management
• Occupational therapists treating upper extremity lymphedema
• Oncology rehabilitation specialists
• Vascular therapy clinics

Key features of this template:

• Detailed limb measurement sections for accurate swelling assessment
• Cancer treatment history tracking (surgery, radiation, chemotherapy)
• Compression garment usage and compliance documentation
• Infection and cellulitis episode tracking
• Functional limitation assessment
• Insurance and referral information capture

With Paperform's conditional logic, you can show relevant follow-up questions based on patient responses—such as displaying additional measurement fields only when certain limbs are affected, or gathering detailed cancer treatment history only when applicable. The clean, professional layout works seamlessly on any device, making it easy for patients to complete in your clinic or from home before their first appointment.

Enhance your workflow with automation: Connect this form to your practice management software, send submission data to your EHR system, or use Stepper to automatically create patient folders, send welcome packets, and schedule follow-up measurements. You can also use Papersign to collect required consent forms and treatment agreements alongside your intake process.

Trusted by lymphedema therapy practices worldwide, this Paperform template helps you deliver professional, organized care while reducing administrative burden and improving your patient intake experience.