Physical therapy assessment template 2026

1. Click ‘Get Form’ to open the physical therapy assessment template in the editor.
2. Begin by entering the District and School Year at the top of the form. This sets the context for your evaluation.
3. Fill in the Student’s Name and Date of Birth (DOB) to identify the individual being assessed.
4. Complete the fields for School, Therapist, Diagnosis, Physician, and Medicaid Number to provide essential background information.
5. Assess and document ROM Limitations and Muscle Tone in their respective sections, ensuring accurate descriptions for effective treatment planning.
6. Evaluate Gross Motor Skills by filling out each activity section such as Supine to sit, Sitting Balance, and Gait. Use clear observations to guide future therapy goals.
7. In the Assessment section, summarize findings and set specific GOALS and a PLAN tailored to the student’s needs.
8. Finally, have the Physical Therapist sign and date the form at the bottom to validate your assessment.

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