Occupational therapy referral form
Turn incomplete referrals into thorough clinical handoffs, so occupational therapists can focus on care instead of chasing missing details.
When occupational therapy referrals arrive missing key clinical details, intake teams spend time chasing information instead of scheduling care, and patients wait longer than they should for care. Typeform's occupational therapy referral form template gives healthcare providers, clinics, and hospitals a structured way to collect everything the occupational therapy team needs before a referral is submitted.
Typeform guides respondents through one question at a time, so completing a referral never feels like navigating a clinical intake system. Conditional logic branches questions based on the patient's presenting condition—a patient referred for post-surgical rehabilitation sees different follow-up questions than a patient referred for cognitive or sensory processing support. This means that every referral arrives with the right information for that patient, keeping the referral focused on the details the OT team needs to provide patient care.
Connect submissions to Google Sheets, Airtable, or your practice management system via Zapier—referrals arrive organized and ready for the OT team to review. This form takes minutes to set up, works on any device, and is easy to customize for different therapy specialties or clinic requirements. The more complete the referrals, the faster patients receive care.
An occupational therapy referral form is a structured document that healthcare providers use to refer patients to occupational therapy services. It captures the patient's diagnosis, functional limitations, therapy goals, and any relevant medical history the occupational therapy team needs to plan an effective treatment program.
Referrals that arrive incomplete slow down the intake process for the OT team—and delay care for patients who are already waiting. A structured referral form ensures every submission arrives with the clinical detail needed to schedule an assessment and begin treatment planning without a follow-up call. Clinics use it to reduce intake bottlenecks, and referring physicians use it to communicate patient needs accurately the first time.
Cover the essentials that the occupational therapy team needs to begin treatment planning:
- Referring provider name, clinic, and contact details
- Patient name, date of birth, and contact information
- Primary diagnosis and relevant medical history
- Specific functional limitations that prompted the referral
- Prior therapy history and outcomes (if applicable)
- Patient's living situation and daily activity requirements
- Therapy goals and any urgency or scheduling considerations
Yes. The form is designed to cover a range of occupational therapy specialties—from neurological rehabilitation to post-surgical recovery. Conditional logic branches questions based on the patient's presenting condition, so each referral captures the details relevant to that specific therapy type without asking referring providers to wade through fields that don't apply. One form handles the full scope of your referral needs.
Track submitted referrals in a shared Google Sheet or Airtable so your team knows which patients are awaiting intake and how long each referral has been open. Set a follow-up window—five to seven business days is a reasonable starting point—and flag any referral that hasn't received a response within that timeframe. A consistent follow-up process protects patients from falling through the cracks between the referring provider and the occupational therapy clinic.
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