Orthopedics Intake Form

The Orthopedics Intake Form is built for orthopedic surgery practices, sports medicine clinics, and musculoskeletal specialty offices. It captures detailed information about bone, joint, and muscle complaints: injury mechanism, onset and progression, pain characteristics, functional impact, imaging history, and previous orthopedic treatments.

The joint function assessment section uses validated screening questions to evaluate range of motion limitations, instability, locking, clicking, and weight-bearing capacity. Patients can indicate affected joints on a visual body diagram. Activity limitations are documented across categories including work, sports, daily living, and sleep.

Surgical history is captured with specific attention to orthopedic procedures, hardware placement, and post-surgical complications. The imaging section documents previous X-rays, MRI, CT scans, and bone density studies with dates and facilities. This template also captures workers' compensation and auto accident information when applicable, streamlining the administrative process for injury-related visits.