Hand & Upper Extremity Evaluation Form
A hand therapy evaluation template with bilateral ROM, grip and pinch strength, edema, sensation, special tests, and functional use. Free to download.
- Bilateral AROM / PROM grid by joint
- Grip, lateral, three-point, and tip pinch rows
- Special tests checklist and functional grasp notes
| Joint | R AROM | L AROM | Notes | Sign |
|---|---|---|---|---|
| Joints measured | ||||
A complete hand therapy evaluation
Organized the way hand therapists actually measure — bilateral, joint by joint.
- AROM and PROM for right and left, by joint
- Grip and three pinch measures with norms
- Edema, Semmes-Weinstein, and two-point discrimination
- Special tests checklist
- Functional grasp patterns and ADL impact
Who it’s for
Hand therapistsCHTsOutpatient OTsOrtho clinicsClinic ownersBuilt for caseloads where precise, repeatable measurement is the whole job.
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
Which joints and motions are included?
The ROM grid is open-ended so you can enter whichever joints you’re measuring — wrist, MCP, PIP, DIP, thumb — with AROM and PROM recorded for right and left.
Does it capture grip and pinch strength?
Yes. The strength table has rows for grip plus lateral, three-point, and tip pinch, with a column for norms or comparison notes.
Can I document post-surgical precautions?
Yes. The header has fields for date of surgery and protocol or precautions, so restrictions stay visible at the top of the sheet.
Which special tests are listed?
Common screens including Phalen’s, Tinel’s, Finkelstein’s, Allen’s, Froment’s, and Watson shift, with space to note others.
How do I show progress between visits?
On paper you compare sheets side by side. Terapiq trends each measurement visit over visit, so improvement is visible without rebuilding a spreadsheet.
Grab the form — it’s on us
Free, fillable, and ready to brand. Download it now and see how much easier this can be.