An occupational therapy intake form that asks about the day, not the diagnosis

Why a generic medical intake fails an OT practice

Most intake forms ask what is wrong. Occupational therapy needs to know what the person can no longer do, which is a genuinely different question and produces genuinely different answers. A patient describing their condition gives you a diagnosis they were handed; the same patient describing their morning gives you the goal you will actually work toward. That is why an occupational therapy intake form built on a general medical template — symptoms, systems, medications and little else — leaves the therapist to extract everything useful in the first session. This preset is organised around daily function from the start. Editable throughout, PDF immediately, no signup and no email wall.

• Built for HIPAA-compliant workflows

• Free to start — 50 patient actions each month

What an OT intake form template usually covers

The administrative layer first: contact details, referral source and referring provider, insurance where your workflow needs it, and relevant medical history, surgeries and current medications. Then the part that matters. In adult mode: self-care such as dressing, bathing and grooming; home tasks including cooking, cleaning and managing medication; work or study demands; driving and community access; leisure and the activities the person has stopped doing. In paediatric mode the same idea, age-appropriately: dressing and feeding independence, handwriting and school tasks, play and peer interaction, sleep routines, and what a typical morning looks like at home. Both modes ask for equipment already in use, the home or classroom setup, and who else supports the person day to day. Finally, and most usefully, what the person or family most wants to be able to do again.

Function described, never scored

Everything in the functional sections is recorded in the words of the patient or their caregiver, and stays that way. The form contains no standardised assessment, reproduces no published sensory, developmental or independence measure, and produces no score of any kind. Those instruments carry their own administration rules, licensing and interpretation requirements, and belong in your clinical workflow rather than on an intake page. What you get instead is the raw material an evaluation builds on — the patient's own account, gathered before the appointment rather than during it, which is both more candid and considerably faster than working through the same ground in the room.

Edit it in plain language, download exactly what you built

Rename the form, rewrite any question or helper text, mark fields required or optional, switch between adult and paediatric modes, and add, duplicate, reorder or remove sections. A hand therapy caseload, a paediatric sensory practice and a neuro rehabilitation service will shape this very differently from the same preset, and a pediatric OT intake form and an adult OT intake form are two modes of one document rather than two files to keep in step. Treat it as an occupational therapy intake starting point rather than a finished document. A default PDF is ready as soon as the page loads, and after any change a new PDF is generated from your current version, so what downloads matches what is on screen. It prints on US Letter with clean page breaks and real writing space.

A paediatric OT practice, half an hour

A practice working mostly with school-age children starts from this preset in paediatric mode. The lead therapist expands the school tasks section, since handwriting and classroom participation are behind most of her referrals. She adds a question asking the family to describe a typical morning from waking to leaving the house, which turns out to surface more than any checklist she had used before. She removes a driving section that will never apply. She keeps sensory preferences as a description rather than adding the scored measure a colleague suggested, since that belongs in her evaluation. Half an hour, and her first sessions start with a goal already on the table.

Reported by the patient, evaluated by the therapist

The form collects what a patient or caregiver reports and hands it over. It draws no clinical findings, produces no assessment, suggests no diagnosis, and proposes no treatment plan or recommendations — that work belongs to a licensed occupational therapist conducting an evaluation, which this document supports rather than substitutes for. This is an original document rather than a copy of any published instrument or association form. Have a licensed OT review the functional sections for your caseload and setting, and your attorney or compliance lead review consent, cancellation and any policy wording you attach. DocRepute is HIPAA-focused and built for HIPAA-compliant workflows, and because this is a public builder, build the blank form here rather than entering real patient details.