Physical Therapy Intake Form
What a physical therapy intake form asks, why each part matters, and how clinics collect it.
A physical therapy intake form records why a patient needs therapy: the injury or condition, the pain, how it limits daily life, and their goals. It's also called a PT intake form.
Physical therapy intake form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a physical therapy intake form in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample physical therapy intake questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What brings you to physical therapy?Referral
- Who referred you to us?Referral
- Where do you feel pain?Pain
- How bad is the pain from 0 to 10?Pain
- What is hard for you to do now?Function
- Can you climb stairs without help?Function
- Have you had surgery on this area?History
- Do you take any pain medicine?History
- What would you like to get back to?Goals
- What would a good result look like?Goals
- Have you fallen in the past year?Safety
- Do you feel dizzy when you stand up?Safety
These are examples to read, not a form to fill in.
Physical therapy intake form: FAQ
What is a physical therapy intake form?
It's the form a PT clinic uses before the first visit: why the patient needs therapy, their pain, what is hard to do, and their goals.
Is a PT intake form the same thing?
Yes. PT is short for physical therapy. Clinics use both names for the same form.
What questions are on a physical therapy intake form?
The sample questions on this page cover six areas: the reason for referral, pain, daily function, medical history, goals, and a short safety screen.
Is there a PT intake form template?
The sample questions on this page show a typical set. Every clinic adapts them to its own patients and specialties.
Who fills in a PT intake form?
The patient, or a parent or guardian for a child. The therapist reviews it at the first visit.
What happens after a PT intake form?
The therapist reads it at the first visit, examines the problem area, and agrees goals with the patient.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
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.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
