Physical Therapy New Patient Intake Form Template

Intake Forms Registration Forms Healthcare & Medical Forms Healthcare Physician Physical Therapist Healthcare Administrator

About this free form template

Welcome New Patients with a Professional Physical Therapy Intake Form

Starting physical therapy treatment requires gathering detailed patient information to provide safe, effective care. This Physical Therapy New Patient Intake Form helps PT clinics, rehabilitation centers, and sports medicine practices collect comprehensive patient data before the first appointment.

What This Physical Therapy Intake Form Includes

This template captures everything your clinic needs to prepare for a new patient's first session:

Demographic and contact information for patient records
Referral source and physician details to coordinate care
Current condition and pain scale assessment to understand severity
Mobility limitations and functional restrictions affecting daily life
Surgical history and previous treatments for context
Current medications and allergies to ensure safe treatment
Insurance information and authorization details for billing
Treatment consent and HIPAA acknowledgment for compliance

Perfect for Physical Therapy and Rehabilitation Practices

This form template is designed for:

Physical therapy clinics and private practices
Orthopedic rehabilitation centers
Sports medicine facilities
Hospital-based PT departments
Mobile physical therapy services
Occupational therapy practices

Save Time and Improve Patient Care

With Paperform, your intake form can match your clinic's branding and integrate seamlessly into your website. Submissions automatically flow into your practice management software, Google Sheets, or CRM, eliminating manual data entry and reducing administrative burden on your front desk staff.

The conditional logic built into this template ensures patients only see relevant questions based on their answers, creating a smoother experience. For example, patients who indicate they've had surgery will be prompted for surgical details, while others skip those questions entirely.

Streamline Your Workflow with Stepper

Once a patient submits their intake form, you can use Stepper to automatically create their file in your practice management system, send a welcome email with appointment preparation instructions, notify the assigned therapist, and check insurance eligibility—all without lifting a finger. This automation means your team can focus on patient care instead of paperwork.

HIPAA Considerations

Please note that while Paperform offers robust security features including SOC 2 Type II compliance, Paperform is not HIPAA compliant. For practices requiring HIPAA compliance, you may need to implement additional safeguards or use this form for preliminary information gathering only, with sensitive medical data collected through HIPAA-compliant channels.

Start welcoming new patients more efficiently with this professional physical therapy intake form template.

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Patient Intake Form

Use this intake form template to collect information from new patients for your practice. Collect the details you need prior to their first appointment and easily manage patient records.