Physical Therapy School Services Request Form

Streamline Physical Therapy Referrals with Paperform

When students need physical therapy support in school settings, the referral process needs to be thorough, organized, and compliant. This Physical Therapy School Services Request Form helps special education coordinators, teachers, school nurses, and parents submit detailed PT referrals that capture gross motor concerns, mobility challenges, equipment needs, and relevant orthopedic documentation—all in one professional, easy-to-complete form.

Built for schools and special education teams

Whether you're a special education director managing IEP services, a school nurse coordinating therapy evaluations, or a teacher advocating for student support, this template gives you a structured way to document concerns and request services. The form captures student information, specific motor concerns, current mobility status, adaptive equipment needs, and medical history—ensuring therapists have the context they need to conduct meaningful evaluations.

Paperform's conditional logic reveals follow-up questions based on specific concerns, so you only see fields relevant to each student's situation. Upload medical documentation, orthopedic reports, or previous therapy evaluations directly within the form, keeping everything organized in one submission.

Automate your therapy referral workflow

Once a PT request is submitted, Stepper (stepper.io) can route the referral to the appropriate school therapist, send confirmation emails to parents, create tasks in your special education management system, and even generate evaluation timelines to ensure compliance with IEP deadlines. No more lost referrals or manual follow-up—everything flows automatically from submission to service delivery.

If consent or acknowledgment signatures are needed from parents or medical providers, Papersign (papersign.com) lets you send documents for secure eSignature right after the form is submitted, maintaining a complete digital record tied to the original referral.

SOC 2 compliant and trusted by schools

Paperform is SOC 2 Type II compliant and GDPR ready, giving schools the security and data protection standards needed when handling student health information and special education records. Set up role-based access so only authorized staff can view submissions, and use Paperform's integrations to sync data with your student information system, Google Workspace, or case management tools.

Start with this template and customize it to match your district's referral protocols, evaluation criteria, and documentation requirements—no coding needed.