Physical Therapy Evaluation Request Form

Streamline Your Physical Therapy Intake with Paperform

Getting patients started on their recovery journey shouldn't involve phone tag, paper forms, or back-and-forth emails. This Physical Therapy Evaluation Request Form makes it easy for healthcare providers, physical therapy clinics, and rehabilitation centers to collect comprehensive patient information before the first appointment—so you can focus on treatment, not administration.

Whether you're a private practice, multi-location clinic, or hospital-based rehabilitation center, this form captures everything you need: injury details, pain levels, insurance information, medical history, and appointment preferences. The intuitive design guides patients through each section, reducing incomplete submissions and eliminating the need for follow-up calls.

Why physical therapists choose Paperform

Physical therapy practices need forms that work as hard as they do. With Paperform's conditional logic, you can show or hide questions based on injury type, insurance coverage, or referral source—creating a personalized experience for each patient. The built-in appointment scheduling feature lets patients choose available time slots that work with your calendar, reducing double-bookings and administrative overhead.

Need to collect co-pays or evaluation fees upfront? Paperform's native payment integrations with Stripe, PayPal, and Square make it simple to process payments securely at the time of booking. Plus, with Papersign, you can automatically send consent forms, treatment agreements, or HIPAA authorization documents for eSignature immediately after form submission—keeping your compliance documentation organized and complete.

For practices managing multiple therapists, locations, or specialties, Stepper can route each submission to the right team member, update your patient management system, send appointment reminders, and trigger follow-up workflows—all without manual data entry.

This template is perfect for physical therapists, physiotherapists, occupational therapists, sports medicine clinics, orthopedic rehabilitation centers, and healthcare providers offering therapeutic services. It's designed to improve patient experience, reduce administrative burden, and ensure you have the clinical information needed to deliver effective, personalized care from day one.