Pediatric Occupational Therapy Evaluation Form
A developmental, sensory, and participation evaluation built for kids — milestones, standardized assessments, play and school participation, and family-centred goals. Free PDF.
- Developmental milestone and history sections
- Sensory processing observation checklist
- Standardized assessment scores with interpretation
| Milestone | Achieved | Typical | Notes | Sign |
|---|---|---|---|---|
| Milestones reviewed | ||||
Everything a pediatric evaluation needs
Family-centred and developmentally organized — built for pediatric caseloads.
- Birth, medical, and developmental history
- Parent concerns and priorities
- Milestone table with typical ranges
- Sensory processing observation checklist
- Standardized assessments plus goals
Who it’s for
Pediatric OTsEarly interventionSchool-based OTsSensory clinicsClinic ownersWhether you work in a clinic, a school, or early intervention, this keeps pediatric evaluations thorough and family-friendly.
Love the form? You’ll love not needing it.
The template is great on paper. Terapiq does the same job digitally — no lost sheets, no manual tallies, no chasing signatures.
Capture it in seconds
Fill it in from any device — Terapiq handles the totals, dates, and formatting automatically.
Signatures & audit trail
Sign-offs, dates, and details are captured and time-stamped — ready whenever someone asks.
One place for your clinic
Forms live alongside scheduling, notes, and billing — not in a folder of loose PDFs.
One platform, the whole clinic
This form is just the start. Here’s what else stops being paperwork.
Book in one drag
Click-and-drag appointments, online self-scheduling, and automatic reminders that cut no-shows — across every therapist, room, and location.
Explore scheduling →Notes that draft themselves
Document during the session and let the note assemble itself — goals, minutes, and CPT codes included. Review, sign, done.
See OT documentation →The note becomes the bill
CPT-coded superbills straight from your documentation, live authorization tracking, and self-pay or insurance set per service.
Explore OT billing →More for occupational therapy clinics
🧩 OT practice software
The full picture: scheduling, goals, documentation, authorizations, and billing built around occupational therapy.
See the OT platform →💳 OT billing
CPT-coded superbills, authorization and unit tracking, and pay type set per service — not per client.
Explore billing →📅 Therapy scheduling
Drag-to-book appointments, client self-scheduling, and reminders that keep your calendar full.
Explore scheduling →Reading for OT clinic owners
Form FAQ
What age range is this designed for?
Early intervention through school age. The milestone table and sensory sections work across that span — skip whatever doesn’t apply to the child in front of you.
Can I record standardized assessment scores?
Yes. There’s a dedicated table for assessment name, date, score, and your interpretation, so scores sit alongside your clinical reasoning.
Does it include sensory processing?
Yes — a twelve-item observation checklist covering seeking, avoiding, regulation, and motor planning.
Is there room for developmental and birth history?
Yes. There’s a narrative section for birth, medical, and developmental history, plus a separate space for parent concerns and priorities.
How do I share results with the family or school?
Paper means printing and copying. Terapiq keeps scores on the chart, tracks them over time, and shares progress with families through the portal.
Grab the form — it’s on us
Free, fillable, and ready to brand. Download it now and see how much easier this can be.