Virtual Reality Therapy Equipment Request Form

Virtual reality is transforming therapeutic practice, offering immersive treatment options for anxiety disorders, PTSD, phobias, pain management, and cognitive rehabilitation. This Virtual Reality Therapy Equipment Request Form helps mental health professionals, physical therapists, and healthcare facilities systematically request VR therapy equipment while ensuring patient safety, HIPAA compliance, and clinical outcome tracking.

Whether you're a therapist looking to integrate exposure therapy tools, a clinic manager evaluating equipment for multiple practitioners, or a healthcare administrator planning VR therapy program expansion, this template streamlines the entire request process. Capture essential details about treatment applications, patient populations, safety protocols, technical requirements, and expected clinical outcomes—all in one professional, HIPAA-conscious form.

Built for healthcare providers who need more than basic request forms. This template addresses the unique requirements of therapeutic VR implementation: documenting clinical justification, ensuring patient safety considerations, tracking compliance requirements, and establishing clear success metrics. Perfect for mental health clinics, rehabilitation centers, hospitals, university counseling centers, and private practices introducing innovative treatment modalities.

The form guides requesters through specifying equipment types (headsets, motion controllers, biometric sensors), intended therapeutic applications (exposure therapy, pain distraction, mindfulness training), patient safety protocols, and clinical outcome measurement plans. With conditional logic, the form adapts to show relevant questions based on treatment type and patient population.

Automate your approval workflow with Stepper. Once submitted, use Stepper to route requests to clinical directors for medical necessity review, IT departments for technical feasibility assessment, and procurement teams for vendor evaluation. Automatically create equipment tracking records, schedule staff training sessions, and set up outcome measurement protocols—keeping your clinical innovation process efficient and compliant.

This form is optimized for healthcare practices seeking to modernize treatment approaches while maintaining rigorous safety standards and regulatory compliance. Start with a professional foundation that addresses both clinical and administrative requirements for VR therapy implementation.