Physical Therapy Consent Form
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Physical Therapy Consent Form
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The Physical Therapy Consent Form is designed for outpatient rehabilitation clinics, hospital-based physical therapy departments, and sports medicine practices. It ensures patients understand the nature of physical therapy treatment, the techniques that may be used during their sessions, and their active role in the rehabilitation process.
This template addresses a range of therapeutic interventions including manual therapy, therapeutic exercises, modalities such as electrical stimulation and ultrasound, dry needling, and aquatic therapy. It clearly outlines potential risks including temporary soreness, muscle fatigue, and the rare possibility of injury during treatment. The form also documents the patient's commitment to following their home exercise program and attending scheduled sessions.
Appropriate for physical therapy private practices, hospital outpatient rehab departments, sports medicine clinics, and occupational therapy settings, this form helps practitioners meet informed consent requirements while fostering a collaborative therapeutic relationship built on clear communication and mutual expectations.
What's included
- Patient identification and referring physician details
- Primary condition and diagnosis documentation
- Treatment technique and modality authorization
- Risk disclosure and acknowledgment
- Home exercise program commitment statement
- Patient signature and date fields
- Consent agreement with e-signature
Who uses this template
- Onboarding new patients for outpatient physical therapy programs
- Documenting consent for manual therapy and therapeutic modalities
- Recording patient commitment to home exercise and attendance expectations
- Meeting informed consent requirements for sports rehabilitation services
All form fields
11 fields across 2 pages. Customize any field after signing up.
How to use the Physical Therapy Consent Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Physical Therapy Consent Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Physical Therapy Consent Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 11 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Physical Therapy Consent Form HIPAA compliant?
Yes. All Formisoft templates, including the Physical Therapy Consent Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 11 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Physical Therapy Consent Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Physical Therapy Consent Form for your practice. Set up in minutes.
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