Occupational Therapy Appointment Form
An appointment request and intake template — client details, referral, insurance, scheduling preferences, and policy acknowledgements. Free to download.
- Client, caregiver, and referral details in one place
- Insurance, member ID, and authorization capture
- Cancellation policy and reminder consent boxes
| Date | Time | Service | Provider | Sign |
|---|---|---|---|---|
| Appointments booked | ||||
Everything you need before the first visit
One sheet that captures who, when, and how they’re paying — so nothing stalls at the front desk.
- Client and caregiver contact details
- Scheduling preferences and telehealth option
- Referring provider, NPI, and diagnosis
- Insurance plan, member ID, and authorization
- Policy acknowledgements and reminder consent
Who it’s for
Front desk staffClinic ownersSolo practitionersIntake coordinatorsMulti-site clinicsIf you still take bookings by phone or paper, this keeps intake complete and consistent.
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
Can clients complete this before their first visit?
Yes — it’s fillable, so you can email it ahead and get it back completed, which saves time at the front desk.
Does it capture insurance and authorization details?
Yes: plan, member ID, group number, and authorization with units, alongside the referring provider and NPI.
Is there a cancellation policy acknowledgement?
Yes. There are check boxes for the cancellation and no-show policy plus separate consent for text and email reminders.
Can I use it for telehealth bookings?
Yes. There’s a field for visit type, so in-person and telehealth requests use the same form.
Is it safe to email a completed form?
Ordinary email isn’t secure for health information. Use a secure portal or encrypted email for anything containing PHI — that’s one reason clinics move intake into Terapiq’s 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.