Clinic template

A Cliniko treatment note template for a podiatry initial assessment

This podiatry initial assessment template adds a vascular and neurological foot screen and a diabetes foot risk category to the standard history, examination and plan sections. Build it under Settings > Treatment note templates using Cliniko's Paragraph, Checkboxes, Multiple choice, Single line text, Body chart and Date question types, or import a colleague's exported template.

Last checked 25 Sep 2026 against the sources listed at the end of this page.

Free template · Cliniko

Treatment note: initial assessment: podiatry

The template: 34 fields

Section	Field	Type	Notes
Presenting complaint	Reason for visit, in the patient's words	Paragraph	Cliniko type: Paragraph text.
Presenting complaint	Foot or feet affected	Radio	Cliniko type: Multiple choice. Options: Left / Right / Both.
Presenting complaint	Area affected	Checkboxes	Options: Forefoot / Midfoot / Rearfoot / Heel / Toenails / Skin / Ankle / Other.
Presenting complaint	Onset and duration	Paragraph
Presenting complaint	Referral source	Radio	Options: Self / GP (Medicare CDM) / DVA / Workers compensation / Podiatrist to podiatrist / Other.
Relevant medical history	Diabetes status	Radio	Options: No known diabetes / Type 1 / Type 2 / Pre diabetes / Unknown. Drives whether the risk screen below is completed in full.
Relevant medical history	Years since diabetes diagnosis and recent HbA1c if known	Text
Relevant medical history	Vascular history	Checkboxes	Options: Peripheral arterial disease / Previous ulcer / Previous amputation (partial or full) / Smoker / None known.
Relevant medical history	Other relevant conditions	Paragraph	Rheumatoid arthritis, gout, peripheral neuropathy of any cause, connective tissue disease.
Relevant medical history	Medications	Paragraph	Anticoagulants and any medication affecting wound healing or sensation.
Relevant medical history	Footwear currently worn	Paragraph
Vascular screen	Dorsalis pedis pulse	Radio	Options: Palpable both feet / Palpable one foot only / Not palpable, Doppler used / Not palpable, Doppler not available.
Vascular screen	Posterior tibial pulse	Radio	Same options as dorsalis pedis pulse.
Vascular screen	Capillary refill time	Radio	Options: Normal, under 3 seconds / Delayed, 3 seconds or more / Not assessed.
Vascular screen	Skin colour, temperature and trophic changes	Paragraph	Pallor, hair loss, shiny skin, temperature difference between feet.
Vascular screen	Ankle brachial pressure index	Text	Score if performed, or note not performed and why.
Neurological screen	10g monofilament testing	Paragraph	Record the sites tested and whether sensation was present or absent at each, not just a pass or fail overall.
Neurological screen	Vibration sense (128Hz tuning fork)	Radio	Options: Present and normal / Reduced / Absent / Not assessed.
Neurological screen	Sharp and blunt discrimination	Radio	Options: Normal / Reduced / Absent / Not assessed.
Neurological screen	Ankle reflexes	Radio	Options: Present / Reduced / Absent / Not assessed.
Foot risk category	Structural and biomechanical findings	Paragraph	Deformity, callus pattern, prior surgery, pressure areas.
Foot risk category	Skin and nail inspection	Paragraph	Ulceration, tinea, ingrown nails, interdigital maceration.
Foot risk category	Diabetes foot risk category	Radio	Options: Not applicable, no diabetes / Low risk / Moderate risk / High risk / Active foot disease. Base the category on the vascular and neurological findings above, plus deformity and ulcer history, and record the reasoning in the next field.
Foot risk category	Risk category reasoning and review interval	Paragraph	Why this category was chosen and when the screen is due again.
Body chart	Foot map	Body chart	Use a foot specific chart if your Cliniko account has one, or a full body chart with a note that only the feet apply.
Gait and function	Gait observation	Paragraph
Gait and function	Range of movement, key joints	Paragraph	First MTPJ, subtalar and ankle as relevant to the complaint.
Assessment	Clinical impression	Paragraph	Working diagnosis and differentials.
Consent	Informed consent	Checkboxes	Options: Findings explained / Treatment options and material risks explained / Costs explained / Questions answered / Consent given for assessment and treatment.
Consent	Consent notes	Paragraph	Specific procedures consented to, for example nail surgery or sharp debridement, and anything declined.
Plan	Treatment provided today	Paragraph
Plan	Home care and footwear advice	Paragraph
Plan	Onward referral	Checkboxes	Options: Not required / GP / Vascular surgeon / High risk foot service / Endocrinologist / Other. A high risk or active foot disease result should prompt a tick here.
Plan	Plan and review	Paragraph	Frequency, next review, and when the vascular and neurological screen will be repeated.

Build it in Cliniko

Build it by hand: log in as an Administrator, go to Settings > Treatment note templates, click Add template and name it Podiatry initial assessment.
Add each section above as its own section, then add its questions and set each one's type from Cliniko's six question types: Paragraph text, Single line text, Multiple choice, Checkboxes, Body chart or Date.
For Multiple choice and Checkboxes questions, type in the options listed in the note column exactly, so every practitioner in the clinic records the same wording for the same finding.
Set the diabetes foot risk category as a Multiple choice question so only one option can be selected. Leave the default answer blank rather than pre-selecting Low risk.
Assign the template to your Podiatry initial consultation appointment type so it loads automatically.
Or import it: export a colleague's or another clinic's version as a .json file (Settings > Treatment note templates > select it > Export, using Chrome rather than Safari) and import it through Settings > Treatment note templates > Import.
Cliniko's import also accepts JPG, PNG, WEBP or PDF files up to 5MB. Unsupported question types convert to the nearest available type and formatting may be lost, so check the vascular and neurological screen fields carefully after an import.
Write a test note on a test patient for each risk category option, save it as a PDF, and check the layout and options before practitioners use it on real patients.

AHPRA: The Podiatry Board of Australia applies the same shared Code of conduct as every other registered health profession: records need to be accurate, and to show the reasoning behind a clinical decision. A risk category recorded without the vascular and neurological findings that led to it does not meet that standard on its own.

Why a podiatry initial assessment needs its own screen

A general musculoskeletal template built for physiotherapy does not ask the questions a podiatry initial assessment needs. Two of them carry real clinical weight: is this foot losing its blood supply, and is this foot losing protective sensation. Both can be present with no pain at all, which is exactly why they need dedicated fields rather than depending on a patient volunteering the information. This template puts the vascular and neurological screen straight after history, before the practitioner has moved on to structural findings, so it does not get skipped when a session runs short.

Turning two screens into one risk category

The diabetes foot risk category field exists to summarise the vascular screen, the neurological screen, deformity and ulcer history into one word a receptionist scheduling recalls, or another practitioner picking up the file, can act on without reading every line above it. It is deliberately placed after the findings that justify it, and the reasoning field next to it exists so the category is never just a click with nothing behind it. A patient who moves from moderate to high risk between visits should be visible in that field without anyone re-reading two years of notes.

Recording pulses as palpable, palpable on one side only, or not palpable with or without a Doppler, rather than a single normal or abnormal tick, matters because "not palpable, no Doppler available" is a different clinical situation to "not palpable, confirmed absent on Doppler," and a template that collapses that distinction loses information a vascular referral will need.

Consent for anything sharp

Podiatry initial assessments often move straight into treatment, sharp debridement or nail surgery in the same visit, which is why consent gets its own section rather than sitting inside the plan. The consent notes field is where a specific procedure, not just "treatment" in general, gets recorded as explained and agreed, matching what the shared Code of conduct expects a health record to show about informed consent.

Sources

Cliniko treatment note templates are built under Settings > Treatment note templates using six question types: Paragraph text, Single line text, Multiple choice, Checkboxes, Body chart and Date, and can be assigned to a specific appointment type. Cliniko Help, checked 25 Sep 2026.
An Administrator can export a treatment note template as a .json file for another clinic or colleague to import, and Cliniko recommends using Chrome rather than Safari for the export because Safari tries to open the file instead of saving it. Cliniko Help, checked 25 Sep 2026.
Cliniko's template import accepts JSON, JPG, PNG, WEBP or PDF files up to 5MB, converts unsupported question types to the closest available type, and may lose formatting in the process, so an imported template should be checked before use. Cliniko Help, checked 25 Sep 2026.
The Podiatry Board of Australia sets its Code of conduct at podiatryboard.gov.au/Policies-Codes-Guidelines/Code-of-conduct, adopting the shared Code of conduct for registered health practitioners that applies across all National Boards. Podiatry Board of Australia, checked 25 Sep 2026.
Diabetes Feet Australia publishes the Australian guideline on prevention, detection and management of diabetes-related foot disease as a digital, interactive set of decision-making pathways for health professionals, alongside the print guideline published in the Journal of Foot and Ankle Research. Diabetes Feet Australia, checked 25 Sep 2026.