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Hydrotherapy & Rehab Swim Intake Form

Hydrotherapy & Rehab Swim Intake Form

Start water-based rehab safely with a tailored intake covering the condition, mobility, access needs, and referral details.

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Description

The Hydrotherapy Swim Intake Form gives practitioners a careful way to welcome people into water-based rehabilitation. Clients describe what they’re recovering from, how it happened, and where they’re at, so you can understand their condition fully before planning gentle, supportive sessions in the warmth of the pool.

Questions about current mobility, previous hydrotherapy, other health conditions or medications, and whether they need hoist or step access help you make the pool safe and accessible for them. Referral details, an emergency contact, and contact information complete the intake, so you can coordinate care and greet each client already understanding their needs.

Warm water can make recovery feel possible again. Sign up for a free Fun Forms account to customize the fields and embed this intake form on your website.

Form fields

Everything the Hydrotherapy & Rehab Swim Intake Form above collects — 15 fields across 3 pages, so you can see exactly what it captures before you make it your own.

Rehab in the Water

What are you recovering from?
Short Answer
How did it happen?
Dropdown
Tell us about your condition and where you're at
Long Answer
How mobile are you right now?
Dropdown
Have you done hydrotherapy or pool rehab before?
Yes/No

Health & Access

Any other health conditions or medications?
Long Answer
Do you need hoist or step access to the pool?
Yes/No
Referred by a physio or doctor?
Yes/No
Referrer name (if any)
Short Answer

Your Details

Your name
Name
Age
Number
Email address
Email
Phone number
Telephone
Emergency contact (name & number)
Short Answer
Confirmation
Consent

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Template FAQs

Common questions about the Hydrotherapy & Rehab Swim Intake Form — what it captures, when to use it, and how to make it your own.

What is hydrotherapy swimming?

It’s gentle, water-based rehabilitation that uses the warmth and support of a pool to ease movement and aid recovery from injury, surgery, or long-term conditions. This intake form gathers the health and access details practitioners need to plan safe sessions.

Who is hydrotherapy suitable for?

It suits people recovering from injury or surgery, or managing conditions that make land-based exercise painful, often on referral from a physio or doctor. The form captures each client’s situation so practitioners can tailor sessions to their needs.

Why ask about pool access needs?

Some clients need a hoist or step access to enter the water safely, so the form asks directly. Knowing this in advance lets the practitioner prepare the right equipment and support, so the first session is safe, dignified, and stress-free.

Should I include my referral details?

Yes, if a physio or doctor referred you, add their name so care can be coordinated. Sharing referral details helps the practitioner understand your treatment plan and work alongside the professionals already supporting your recovery.

Why collect an emergency contact?

Because sessions involve people managing health conditions in water, an emergency contact is a sensible safeguard. It means the practitioner can reach someone quickly if needed, adding a layer of reassurance for clients and their families alike.

Is this intake form free to use?

Yes — it’s completely free with a Fun Forms account. You can customize every field, restyle it to match your brand, embed it on your website in seconds, and it needs no coding at all.

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