Occupational Therapy Referral Form
An occupational therapist receiving a referral is trying to answer one question before the patient ever arrives: what does this person want to do that they currently cannot? Not the diagnosis — the diagnosis is the beginning of the answer, not the answer. The stroke is context; the fact that he cannot button a shirt, and that buttoning his shirts matters to him because he volunteers at a school every Thursday, is the treatment. Referrals that carry that functional story let therapy start at week one. Referrals that carry only a diagnosis start with two sessions of discovery that a complete referral would have made unnecessary.
This occupational therapy referral form is built to carry the functional story. It gathers what an OT clinic needs to plan assessment and treatment from the first contact: who is referring, the functional challenges in detail, the daily-living context, prior therapy history, and the urgency that determines how fast the patient is seen.
The Functional Challenge, in Detail
The referral’s center is a structured picture of daily function: which activities of daily living are affected — dressing, bathing, eating, toileting — and which instrumental activities: cooking, managing medications, handling finances, driving, working. A multiple choice battery maps the affected areas fast, and a long text section gives the referrer room for the specifics that shape treatment: the dominant hand affected, the tremor that appears only at mealtime, the cognitive changes the family has noticed. Where graded ratings help the clinic triage, an opinion scale captures how much independence remains in the affected activities.
This is the material that lets the clinic book the right assessment length, assign the right therapist, and prepare the right equipment before the first visit — rather than discovering all three in the room.
Prior Therapy, Documented Honestly
What has already been tried determines what should be tried next. The referral captures whether the patient has received occupational therapy before, what it addressed, what helped, and what plateaued — along with relevant surgical history, and conditions that will shape the therapy plan. The returning patient whose last course of therapy stalled on hand strength needs a different opening plan than the first-time referral, and the clinic that knows this at booking schedules accordingly.
Urgency and Format, Structured for Scheduling
OT clinics schedule around capacity the way every specialty does, so the referral states its own priority: routine, prompt, or urgent — with conditional detail where urgency is high, because a referral marked urgent without context is just a louder queue item. The preferred format question matters in modern therapy practice: an in-person evaluation and a telehealth session have different preparation paths, and knowing the preference at referral lets the clinic offer the right appointment type the first time it calls. Both urgency and format are captured as structured dropdown selections, keeping the intake queue sortable at a glance.
Records Attached, Consent Recorded
The reports that inform therapy planning — physician notes, surgical summaries, imaging where relevant, prior therapy discharge summaries — attach directly via file upload, staying with the referral they belong to. Where your workflow requires documented authorization for sharing clinical information, a legal acknowledgement records it within the submission. Completed referrals flow into the clinic’s intake queue via webhook and triage in one reviewable view — by urgency, by condition type, by therapist availability. Related therapy and clinic formats are collected under healthcare form templates.
Frequently Asked Questions
What is an occupational therapy referral form?
A structured referral into OT services that carries what treatment planning actually runs on: the affected daily-living activities in detail, the functional challenges observed, prior therapy history, urgency, and preferred appointment format — complete enough that the clinic can plan the right assessment before the patient arrives.
Why does functional detail matter more than diagnosis?
Because occupational therapy treats function, not diagnosis. Two patients with identical diagnoses need entirely different therapy depending on which daily activities are affected and what those activities mean in their lives. The functional story is what turns a referral into a treatment plan.
What should referrers include about prior therapy?
Whether the patient has had OT before, what it targeted, what improved, and where progress stalled. Previous therapy is the single best predictor of what the next course should do differently — and it is the detail most often missing from referrals that arrive with only a diagnosis.
Can referring providers upload supporting reports?
Yes — physician notes, surgical summaries, prior therapy discharges, and relevant imaging attach directly to the referral. Attached at submission, they reach the treating therapist before the evaluation instead of being chased afterward.
How is referral urgency handled?
Through a structured urgency field with conditional context for high-priority cases, which drives the clinic’s triage queue directly. Urgent referrals surface at submission rather than depending on someone noticing a marked-up fax.
How should referral information be protected?
Encrypted transmission, access limited to clinic staff involved in the patient’s care, records attached to their referral rather than emailed separately, and documented authorization where your privacy procedures require it.