Home › Healthcare & clinics › Physical therapy body chart

Physical therapy evaluation form with a body diagram

For an evaluation, where the problem is matters as much as what it is. Let clients mark it on a diagram, then answer your follow-up questions.

Try it now

Name *

Circle or mark a spot on the outline *

Demo only — nothing here is sent.

Client marks injury location and spread on the body outline.

Follow with symptom, activity-limit, and pain-scale fields.

Send the same form again after a few weeks to compare the marks.

Yes. Paste a link to any image as the doodle background.

No. They open your link and submit; only you log in.