---
title: Residential Traumatic Brain Injury Facility Application Form Template | Paperform
description: Professional TBI residential care application template for rehabilitation facilities. Collect injury severity, rehabilitation goals, therapy needs, and medical history for informed placement decisions.
url: "https://paperform.co/templates/residential-traumatic-brain-injury-facility-application"
type: static
generatedAt: "2026-03-28T00:45:03.036Z"
---

[← Back to free form templates](/templates/)    ![Residential Traumatic Brain Injury Facility Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/residential-traumatic-brain-injury-facility-application.png)
    [Preview](https://_preview.paperform.co/ai-template/residential-traumatic-brain-injury-facility-application) [Use this template for free](/create?ai-template=residential-traumatic-brain-injury-facility-application)    [Application Forms](/templates/category/applications/) [Healthcare](/templates/industry/healthcare/)[Senior Care](/templates/industry/senior-care/) [Nurse](/templates/role/nurse/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Caregiver](/templates/role/caregiver/)     About this free form template
### Streamline Your TBI Residential Facility Admissions with Paperform

Finding the right residential care facility after a traumatic brain injury is a critical decision that requires careful assessment and coordination. This **Residential Traumatic Brain Injury Facility Application** template is designed specifically for rehabilitation centers, long-term care facilities, and specialized TBI residential programs to collect comprehensive applicant information in a professional, compassionate format.

#### Why This Template Works for TBI Facilities

Traditional paper applications can be overwhelming for families already dealing with the stress of a brain injury. This digital form template creates a smooth, logical flow that gathers essential medical history, injury severity, cognitive assessment, rehabilitation goals, and therapy requirements—all in one secure submission. The form is structured to help your intake team make informed placement decisions while providing families with a clear, supportive application experience.

Healthcare facilities, rehabilitation centers, and senior care organizations trust Paperform because it combines **SOC 2 Type II compliance** with an interface that's actually easy to use during difficult times. Your admissions team can customize questions based on your specific program offerings, and conditional logic ensures applicants only see relevant sections based on their injury type and care needs.

#### Complete Assessment in One Professional Form

This template captures everything your clinical team needs for initial screening:

 - **Applicant demographics and emergency contacts** with insurance information
 - **Detailed injury history** including date of injury, cause, and severity classification
 - **Current functional abilities** across cognitive, physical, and behavioral domains
 - **Medical background** including diagnoses, medications, and treating physicians
 - **Therapy needs assessment** for occupational, physical, speech, and cognitive therapies
 - **Rehabilitation goals** set by families and referring providers
 - **Living arrangement preferences** and any special accommodation needs
 - **Financial and insurance verification** to streamline the admissions process

The form uses conditional logic to adapt questions based on injury severity and specific deficits, ensuring you collect comprehensive information without overwhelming applicants with irrelevant questions.

#### Automate Your Admissions Workflow with Stepper

Once an application is submitted, your work is just beginning. With **[Stepper](https://stepper.io)**, Paperform's AI-native workflow builder, you can automate the entire post-submission process. Route applications to clinical reviewers based on injury type, automatically create patient files in your EHR or case management system, send confirmation emails with next steps to families, and schedule intake assessments—all without manual data entry.

Stepper can even check insurance eligibility, notify your medical director when priority cases arrive, and keep families updated as their application moves through your review process. This means faster placement decisions and a more supportive experience for families when they need it most.

#### Designed for Healthcare Providers and Care Coordinators

Whether you're a **healthcare administrator**, **admissions coordinator**, **case manager**, or **clinical director** at a TBI rehabilitation facility, assisted living community, or specialized neurorehabilitation center, this template gives you a professional starting point that reflects the clinical rigor families expect.

The form's clean, accessible design works beautifully on any device, which is essential when family members might be filling it out from a hospital waiting room or care conference. You can add your facility's branding, embed it on your website, or send it as a standalone link to referring physicians and case managers.

#### Secure, Compliant Data Collection You Can Trust

While Paperform is not HIPAA compliant, it does offer **SOC 2 Type II compliance** and robust security features suitable for initial screening and intake workflows. For facilities that need additional document signing—such as consent forms, financial agreements, or treatment authorizations—you can seamlessly connect submissions to **[Papersign](https://papersign.com)** to send legally binding eSignature packets that keep everything linked to the original application.

#### Integration with Your Existing Systems

Paperform connects with the tools healthcare facilities already use. Send applications directly to **Google Sheets** or **Airtable** for tracking, ping your **Slack** channel when urgent referrals arrive, or use **Stepper** to update your CRM, scheduling system, or patient management software. No developer needed—just set up the connections that make sense for your admissions workflow.

#### Built for Compassionate, Efficient Care Coordination

Residential TBI care requires balancing clinical assessment with genuine empathy for families navigating a difficult journey. This template helps your facility gather the detailed information your team needs while creating a respectful, organized experience that builds trust from the very first touchpoint.

**Paperform** is trusted by over 500,000 teams worldwide and offers 30,000+ professionally designed templates. Start with this TBI residential application template and customize it to match your facility's specific programs, therapy offerings, and admission criteria—no coding required.
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