---
title: Remote Physical Therapy Assessment Form Template | Paperform
description: Professional telehealth physical therapy assessment form with pain scales, video uploads for range of motion, exercise tolerance questionnaire, and equipment checks for remote patient evaluations.
url: "https://paperform.co/templates/remote-physical-therapy-assessment-form"
type: static
generatedAt: "2026-03-28T00:45:01.702Z"
---

[← Back to free form templates](/templates/)    ![Remote Physical Therapy Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/remote-physical-therapy-assessment-form.png)
    [Preview](https://_preview.paperform.co/ai-template/remote-physical-therapy-assessment-form) [Use this template for free](/create?ai-template=remote-physical-therapy-assessment-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/) [Physician](/templates/role/physician/)[Therapist](/templates/role/therapist/)[Physical Therapist](/templates/role/physical-therapist/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Remote Physical Therapy Assessment Made Simple

Physical therapy doesn't stop when your patients can't make it to the clinic. Whether you're expanding telehealth services, supporting rural patients, or offering flexible care options, this **Remote Physical Therapy Assessment Form** helps you gather everything you need for an effective virtual consultation.

Built for physical therapists, rehabilitation clinics, and healthcare providers offering telehealth services, this template captures detailed patient information including current pain levels, functional limitations, range of motion videos, exercise tolerance, and home equipment availability—all before your virtual appointment begins.

#### What makes this form essential for telehealth PT

This assessment form streamlines your remote evaluation process by collecting standardized pain scales, functional questionnaires, and visual documentation that would traditionally require an in-person visit. Patients can upload videos demonstrating their range of motion and movement patterns, giving you valuable observational data to inform your treatment plan.

The structured format ensures you capture medical history, current symptoms, activity limitations, and environmental factors (like available exercise equipment) that impact your ability to design effective home exercise programs. Conditional logic adapts questions based on patient responses, creating a personalized assessment experience.

#### Seamless integration with your telehealth workflow

This Paperform template integrates effortlessly with your existing practice management tools. Send completed assessments directly to your EHR system, CRM, or project management platform. Use **[Stepper](https://stepper.io)** to automate follow-up workflows—trigger appointment confirmations, send exercise programs, or schedule progress check-ins based on assessment responses.

Need patient consent or treatment agreements? Connect **[Papersign](https://papersign.com)** to turn submitted assessments into legally binding telehealth consent forms with secure eSignatures, maintaining proper documentation and HIPAA-aligned processes.

With Paperform's SOC 2 Type II compliance and secure infrastructure, you can confidently collect sensitive health information while maintaining the professional standards your practice requires. Start providing exceptional remote physical therapy care without the technical headaches.
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