Physical Therapy Clinic Emergency Contact Form

Streamline Patient Safety and Clinical Intake with Paperform

Physical therapy clinics need reliable systems to collect critical patient information before treatment begins. This Physical Therapy Clinic Emergency Contact Form combines emergency preparedness with clinical intake, ensuring you have all the essential details—from emergency contacts and referring physicians to injury history and insurance pre-authorization—in one organized, professional form.

Built specifically for physical therapy practices, rehabilitation centers, sports medicine clinics, and orthopedic therapy providers, this template captures everything your clinical and administrative teams need to deliver safe, effective care from day one.

Why Physical Therapists Choose Paperform

Instead of juggling paper clipboards, PDF forms, and scattered spreadsheets, Paperform gives you a single, brandable digital form that patients can complete on any device before their first appointment. Conditional logic ensures you only ask relevant follow-up questions based on injury type or insurance details, while integrated calculations can automatically score pain scales or flag high-risk patients.

With Paperform's doc-style editor, you can easily customize this template to match your clinic's branding, add your logo, adjust question wording for your patient demographic, and include consent language that meets your state or country requirements. Forms can be embedded directly into your website, shared via email or SMS, or accessed through a custom domain.

Automate Your Clinical Workflows with Stepper

Once a patient submits their emergency contact and intake information, Stepper can automatically route that data into your practice management system, alert the treating therapist, create the patient file in your EHR, and send insurance details to your billing team for pre-authorization follow-up—all without manual data entry.

Whether you're a solo practitioner or managing a multi-location clinic, this template helps you deliver safer, more organized patient care while reducing administrative burden and ensuring compliance with emergency preparedness standards.