Physical Therapy Session Log Form
Use this form to record details of a physical therapy visit, including session timing, treatment provided, patient response, progress notes, home program, and follow-up.
Patient and Session Details
Patient Name
*
Date of Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Appointment / Session Time
*
Hour Minutes
AM
PM
AM/PM Option
Therapist Name
*
Session Type
*
Initial Evaluation
Follow-up Session
Discharge Session
Re-assessment
Treatment Location
Session Duration (Minutes)
*
Clinical Session Log
Interventions Performed
*
Manual Therapy
Therapeutic Exercise
Gait Training
Stretching
Balance Training
Heat/Ice
Electrical Stimulation
Home Exercise Review
Other
Body Area Treated
*
Treatment Goals Addressed
Patient Response to Treatment
Pain Level Before Session
No Pain
1
2
3
4
5
6
7
8
9
Worst Pain
10
1 is No Pain, 10 is Worst Pain
Pain Level After Session
No Pain
1
2
3
4
5
6
7
8
9
Worst Pain
10
1 is No Pain, 10 is Worst Pain
Functional Progress Notes
Home Program and Follow-Up
Home exercise program assigned
Patient adherence since last session
Yes
Partially
No
Not applicable
Next appointment date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Next appointment time
Hour Minutes
AM
PM
AM/PM Option
Follow-up instructions
Additional notes or recommendations
Submit Session Log
Should be Empty: