Physical Therapy Intake Forms

Most clinics use one general intake form for every new patient, then add a body-region or condition form, such as low back, knee or pelvic floor. Many also use progress questionnaires to track change during the plan of care.

It usually asks where the pain or problem is, how and when it started, what makes it better or worse, past surgeries and injuries, medicines, and which daily activities, work tasks or sports are hard right now. It also asks about the patient's goals.

Not always. According to APTA, all 50 states now allow some form of direct access to a physical therapist without a referral, though many states set conditions. Insurance plans may still require one, so intake forms often ask about referral and coverage.

These cases often involve a claim, so the form asks for the date and details of the accident or injury, the claim or case number, and the insurer or employer contact. The clinical questions stay close to the general intake.

AI Doctor, a real-time AI healthcare assistant avatar, asks the intake questions as a conversation, in the patient's own language, and collects the answers for the team to review.

Start with the general physical therapy intake form, since every new patient fills one in. Then add forms for the conditions you see most, such as low back, neck, knee or shoulder, and a progress questionnaire for follow-up visits.

No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.

Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.