RehabDox

Physical Therapy Practice Management

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Consent Forms

Ctrl+K

Patient Kiosk

Share this link or QR code with patients to complete consent forms.

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Consent Form Templates

Name	Type	Version	Status	Last Updated	Actions
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1

Patient

2

Type

3

Schedule

4

Review

Select Patient

Recent Patients

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Select Appointment Type

Initial Evaluation

First time assessment

Follow-up / Visit

Returning patient

Re-Evaluation

Progress assessment

Discharge

Final session

Filter Slots

Therapist

Date

Custom Time (optional)

Notes (optional)

Available Slots

Loading available slots...

Configure Recurring Pattern

Therapist

System will auto-assign available providers

Days Per Week

Mon Tue Wed Thu Fri Sat Sun

Duration

weeks

Preferred Time

Notes (optional)

Appointments Preview 0 total

Select days to see appointments

Review Before Saving

Patient -

Appointment Type -

Duration -

Date & Time -

Therapist -

Notes -

Patient Reminders

24 hours before

1 hour before

Patient

Time

Type & Status

Reason for Visit

Clinical Notes

Loading notes...

Messages

Assign to Clinic *

First Name *

Last Name *

Date of Birth *

Gender

SSN

Date of Injury For medical lien or workers' comp cases

Phone

Email

Address

City

State

ZIP

Provide emergency contact information for the patient. This will be used in case of emergencies.

Contact Name

Relationship

Phone

Alternate Phone

Primary Insurance

Insurance Type

Payer Name

Payer ID

Policy Number

Insurance Verification

Verify insurance is active and check plan coverage. Click "Validate Insurance" to verify insurance details are correct and see the number of visits allowed by the plan. Authorization is obtained later when treatment begins.

Plan Allowed Visits

Authorization History

Status	Auth Number	Authorized Visits	Expiry Date	Validated On	Actions
No authorization history available

Attorney Information

Attorney Name

Attorney Phone

Attorney Email

Secondary Insurance (Optional)

Insurance Type

Payer Name

Payer ID

Policy Number

Insurance Verification

Verify insurance is active and check plan coverage. Click "Validate Insurance" to verify insurance details are correct and see the number of visits allowed by the plan.

Plan Allowed Visits

Authorization History

Status	Auth Number	Authorized Visits	Expiry Date	Validated On	Actions
No authorization history available

Attorney Information

Attorney Name

Attorney Phone

Attorney Email

Upload patient documents such as insurance cards, ID, referrals, or medical records. All files are encrypted at rest for HIPAA compliance.

Document Category

Description (Optional)

Upload Documents

Drag and drop files here or click to browse

Supported: PDF, JPG, PNG, DOC, XLS, TXT (Max 25MB each)

Uploaded Documents

File Name	Category	Size	Uploaded	Actions

Patient

Time

Type & Status

Reason for Visit

Clinical Notes

Loading notes...

1

Patient

2

Type

3

Schedule

4

Review

Select Patient

Recent Patients

Loading recent patients...

Select Appointment Type

Initial Evaluation

First time assessment

Follow-up / Visit

Returning patient

Re-Evaluation

Progress assessment

Discharge

Final session

Filter Slots

Therapist

Date

Custom Time (optional)

Notes (optional)

Available Slots

Loading available slots...

Configure Recurring Pattern

Therapist

System will auto-assign available providers

Days Per Week

Mon Tue Wed Thu Fri Sat Sun

Duration

weeks

Preferred Time

Notes (optional)

Appointments Preview 0 total

Select days to see appointments

Review Before Saving

Patient -

Appointment Type -

Duration -

Date & Time -

Therapist -

Notes -

Patient Reminders

24 hours before

1 hour before

Patient

Time

Type & Status

Reason for Visit

Clinical Notes

Loading notes...

Assign to Clinic *

First Name *

Last Name *

NPI *

Credentials

Specialty

Taxonomy

Email

Phone

License Number

License State

License Expiry

Default Appointment Duration (min)

Profile Color

Active

Work Schedule (Duty Hours)

Set the provider's working hours for each day. Available slots will be generated based on this schedule.

Day	Available	Start Time	End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Provider Signature

Upload a signature image (JPG or PNG) that will be used when signing clinical notes with the {{provider_signature}} placeholder.

No signature uploaded

Upload Signature Image Max 2MB. JPG or PNG format.

User Account (Auto-Created)

A user account will be automatically created for this provider using the email above.

Password *

Required for user account creation

Care Episode Details

Patient

-

Primary Provider

-

Diagnosis

-

-

Status

-

Start

-

End

-

Visits

-

Treatment Plan

Visit Frequency

-

Goals

-

Plan of Care

-

Appointments 0

No appointments

Clinic Information

Clinic Name *

Phone

Email

Address

City

State

ZIP

Tax ID

NPI

Plan

Initial Location

Location Name *

Time Zone *

This will be the default location for this clinic. You can add more locations later.

Clinic Administrator

Admin First Name *

Admin Last Name *

Admin Email *

Admin Password * Minimum 8 characters

Assign to Clinic *

First Name *

Last Name *

Email *

Phone

Role *

Password *

Minimum 8 characters

Provider Association

Link to Provider Select a provider if this user is a clinician account

No Provider

Active

Create HTML templates with placeholders that will be replaced with actual patient and clinic data when generating the PDF.

Template Name *

Status

Active (available for use)

Description

Clinic * Template will be available only for this clinic

Location * Template will be used for this specific location

Available Placeholders

Patient Information

{{PatientName}} - Full name
{{PatientAddress}} - Full address
{{DateOfInjury}} - Date of injury

Attorney Information

{{AttorneyName}} - Name
{{AttorneyAddress}} - Address
{{AttorneyPhone}} - Phone
{{AttorneyEmail}} - Email

Provider Information

{{ProviderName}} - Name
{{ProviderSignature}} - Signature image

Clinic Information

{{ClinicName}} - Clinic name
{{ClinicAddress}} - Full address
{{ClinicPhone}} - Phone number
{{ClinicEmail}} - Email address

Other

{{TodayDate}} - Current date

Template Content (HTML) * Use the placeholders above to insert dynamic content

Clinic Information

Clinic Name *

Phone

Email

Address

City

State

ZIP

Tax ID

NPI

Plan

Initial Location

Location Name *

Time Zone *

This will be the default location for this clinic. You can add more locations later.

Clinic Administrator

Admin First Name *

Admin Last Name *

Admin Email *

Admin Password * Minimum 8 characters

Assign to Clinic *

First Name *

Last Name *

Email *

Phone

Role *

Password *

Minimum 8 characters

Provider Association

Link to Provider Select a provider if this user is a clinician account

No Provider

Active

Create HTML templates with placeholders that will be replaced with actual patient and clinic data when generating the PDF.

Template Name *

Status

Active (available for use)

Description

Clinic * Template will be available only for this clinic

Location * Template will be used for this specific location

Available Placeholders

Patient Information

{{PatientName}} - Full name
{{PatientAddress}} - Full address
{{DateOfInjury}} - Date of injury

Attorney Information

{{AttorneyName}} - Name
{{AttorneyAddress}} - Address
{{AttorneyPhone}} - Phone
{{AttorneyEmail}} - Email

Provider Information

{{ProviderName}} - Name
{{ProviderSignature}} - Signature image

Clinic Information

{{ClinicName}} - Clinic name
{{ClinicAddress}} - Full address
{{ClinicPhone}} - Phone number
{{ClinicEmail}} - Email address

Other

{{TodayDate}} - Current date

Template Content (HTML) * Use the placeholders above to insert dynamic content