Physical Therapy Forms

Physical Examination and Health Documentation: College of Health, Education and Professional Studies

• Students must follow the University Health Services requirements for documentation submissions: Physical Examination and Health Documentation
• For incoming DPT I students. Please refer to your spring welcome letter /e-mail for details. The information on this form is required for clinic, and students will not be allowed to attend clinic until the form is completed. 

UTC Certificate of Immunization (proof of measles vaccination)

• Immunizations
• All sections of this form must be completed and returned to the address on the form. The information on this form is required by the University, and students will not be permitted to register for classes until the form is completed and returned.

Client/Patient Authorization Forms

(These forms are templates and may be edited after you download them for your specific needs.) 

• Authorization for Photography Form
• Client/patient consent forms for Examination/Evaluation/Intervention at UTC
  (Client/patient consent forms for use of medical information for educational purposes)

Physical Therapist Student Evaluation: Clinical Experience and Clinical Instruction Form

• Student Evaluation Form
• Students will provide the clinical site, center coordinator of clinical education, and the clinical instructor with feedback using the APTA Physical Therapist Student Evaluation: Clinical Experience and Clinical Instruction Form.