Purpose: Although physical therapists (PTs) are equipped and trained with the knowledge of the importance of vital sign assessment and cardiovascular risk factors, there seems to be a discrepancy between the practice guidelines and the actual practice in the clinic. Therefore, the purpose of this study was to observe the frequency with which PTs take and record heart rate (HR) and blood pressure (BP) in the orthopedic outpatient setting during therapy sessions. Methods: Physical therapists from 6 area clinics were observed, including 15 licensed PTs, during 74 patient sessions. The frequency with which the PTs measured patients' BP and HR during initial assessment and/or follow-up treatment sessions was documented. Physical therapist demographics and patient diagnosis, comorbidities, age, and sex were recorded. Results: Of the 74 patient sessions, 15 were initial visits, 54 were follow-up, and 5 were discharge sessions. Although 26% (n = 19) of the patients had hypertension as a comorbidity, initial HR and BP were only taken in 2 sessions, and only once taken after exercise. Conclusions: Within our limited sample, PTs in outpatient settings were not following HR and BP screening or exercise monitoring practice guidelines. This could put patients at risk for cardiovascular incidents during therapy sessions.