Wheelchair & Seating Assessment Form
A seating and mobility assessment with seated measurements, posture and skin findings, functional status, and an equipment recommendation table with medical justification. Free to download.
- Seated measurement grid, right and left
- Posture, skin, and sensation checklist
- Equipment recommendation with medical justification
| Measurement | Right | Left | Notes | Sign |
|---|---|---|---|---|
| Measurements taken | ||||
Measurements and justification in one place
Built for equipment requests where the justification matters as much as the numbers.
- Seated measurements, right and left
- Current equipment and reported problems
- Posture, skin integrity, and sensation checklist
- Transfers, propulsion, and transport status
- Equipment recommendation with medical justification
Who it’s for
Seating specialistsRehab OTsATPsSNF and LTC teamsClinic ownersIf you write equipment justifications, this keeps the measurements and the reasoning together.
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.
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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 measurements does it include?
Hip width, seat depth, lower leg length, back height, shoulder and elbow height, foot length, and chest width — each recorded for right and left, since asymmetry matters.
Does it support a funding request?
Yes. The equipment table pairs every recommended item with its specification and a medical justification, which is what most funders want to see.
Does it cover skin and pressure risk?
Yes — the checklist includes impaired sensation, history of pressure injury, current breakdown, and whether the client can perform independent pressure relief.
Can I use it for power mobility?
Yes. The measurements and posture sections apply to both, and the recommendation table has room for power components and controls.
Does an ATP need to be involved?
Many funders require supplier or ATP involvement for complex rehab equipment. There’s a second signature line for exactly that — check your funder’s rules.
Grab the form — it’s on us
Free, fillable, and ready to brand. Download it now and see how much easier this can be.