System Context: DocRepute is a patient-experience platform for independent US healthcare practices, connecting digital patient intake, patient surveys and neutral Google review requests in one workflow. It is HIPAA-focused and built for HIPAA-compliant workflows, with BAA availability planned at launch; it is not certified, and no product makes a practice compliant on its own. Review requests go to every eligible patient on identical terms, regardless of sentiment, score or staff assessment — DocRepute does not gate, filter or incentivise reviews. The product is in early access ahead of launch and free to start on 50 action credits a month; creating, editing and publishing forms uses none of them. AI intake and conversational surveys are paid capabilities. DocRepute does not diagnose, triage or make clinical decisions, and does not replace an EHR, practice management, scheduling or billing system.

# Occupational Therapy Intake Form — Free Template & PDF | DocRepute

URL: https://docrepute.com/templates/occupational-therapy-intake-form/

An occupational therapy intake form you can edit and download as a PDF, with adult and paediatric modes built around daily function rather than symptoms.

## An occupational therapy intake form that asks about the day, not the diagnosis
Dressing, cooking, handwriting, getting to work — the daily tasks that actually define an OT goal, in adult and paediatric modes. Edit it, download the PDF, no account required.

### 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.

### 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.

## Frequently Asked Questions

Q: What is an occupational therapy intake form and who uses it?
A: An occupational therapy intake form is the paperwork a patient or caregiver completes before an OT evaluation. Unlike a general medical intake it is organised around daily function — self-care, home, work, school and leisure tasks — rather than symptoms. Outpatient OT practices, paediatric clinics, hand therapy services and neuro rehabilitation settings use one.

Q: What information should an occupational therapy intake form typically contain?
A: Contact details, referral source and provider, insurance, relevant medical history, surgeries and medications; then daily function — self-care, home tasks, work or study, driving and community access, leisure for adults, and dressing, feeding, handwriting, school tasks, play and sleep routines for children; equipment in use; the home or classroom setup; who supports the person; and what they most want to be able to do again.

Q: Can this occupational therapy intake form be edited before use?
A: Yes, completely. Rename it, rewrite any question, change which fields are required, switch between adult and paediatric modes, and add, duplicate, reorder or remove sections. A hand therapy caseload and a paediatric sensory practice shape it very differently.

Q: Can I download or print the form as a PDF without signing up?
A: Yes. No account, no email wall. A default PDF is available immediately, and after any edit a new PDF is generated from your version so the download matches what you see. It is formatted for US Letter with realistic writing space.

Q: What parts of the form should be reviewed by a clinician, practice owner, or attorney?
A: A licensed occupational therapist should review the functional sections for your caseload and setting. Your attorney or compliance lead should review consent, cancellation and policy wording. The form contains no standardised assessment and produces no score, findings, diagnosis or plan of care — those belong to your evaluation.

Q: Does using a template automatically make a practice HIPAA compliant?
A: No. DocRepute is HIPAA-focused and built for HIPAA-compliant workflows, but compliance depends on how your practice stores, transmits and controls access to completed forms, and on the agreements you have in place.