Gait Training Documentation Form
Please complete this form to document details of each gait training session.
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant Name
*
First Name
Last Name
Therapist Name
*
First Name
Last Name
Session Duration (minutes)
*
Assistive Device Used
*
Please Select
None
Walker
Cane
Crutches
Parallel Bars
Other
Gait Pattern Observed
*
Please Select
Normal
Antalgic
Ataxic
Trendelenburg
Hemiplegic
Other
Interventions Performed
*
Verbal Cueing
Physical Assistance
Balance Training
Endurance Training
Other
Participant Response / Progress
*
Recommendations / Next Steps
*
Additional Notes
Submit Documentation
Should be Empty: