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Dental Intake Form Template

Easily send and receive your dental intake forms online. Send patients your online intake form to fill out on their phone, tablet, or computer. Patients securely sign and submit completed dental intake forms directly to your account online. Track the progress of new patient dental intake forms, send automated reminders, and receive completed forms online.
Setup a Dental Intake Form
Dental Intake Form

Dental Intake Form Template

Give patients the freedom to complete dental intake forms with any device, anywhere. Streamline the way you collect signatures and consent forms by setting up your dental intake form online.

Easily personalize this dental intake form template with a HIPAA compliant form builder.

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What is included in the Dental Intake Form Template?

01Patient Information

Your dental intake form will require the patient’s information, which will include; the patient’s name, phone number, address, email address, date of birth, social security number, and other identifiable information that is relevant. 

02Dental History

The dental history tab will collect any information you will need to properly assess your patients and prepare for their visit accordingly. Gain insight into patient oral hygiene habits, oral health history and more.

03Health History

Health history will collect important information and give you all you’ll need to correctly assess your patients based on their personal health history, as well as the history of any family members. 

04Privacy Practices

This Dental Intake Form Template packet has also included a notice of privacy practices. Make it as easy as possible to inform your patients of any important information regarding your office or privacy policies!

05Drawing And Diagrams

Allow your patients to draw on an image or diagram in your form to mark areas of pain or parts of the body that may need treatment.

06File Attachment Upload

With file upload fields, your patients can upload their prescriptions, x-rays, medical records, insurance card photos and more with their form submission.

07Mobile-Friendly Forms

Easily build fully-responsive medical forms online that allow your patients to sign and submit on any device, anywhere, at any time.

Discover More Form Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
HIPAA Compliant Electronic Signatures

HIPAA Compliant Electronic Signatures

Collect electronic patient signatures before the appointment. Easily give your patients the ability to digitally sign from their phone, tablet, or computer.

HIPAA Compliant Form Kiosk

Kiosk Form Page

Configure a HIPAA compliant form kiosk page to display new patient registration forms, consent forms, and more.

Account Audit Logs

Account Audit Logs

Keep a detailed record of your account and export your history as a CSV Excel file or Google Sheet. Quickly export every event from your account; or, select a date range or user’s history to export.

Custom Thank You Page

Custom Thank You Page

Create your own custom ‘Thank You’ page to direct patients to upon completion of your forms. Forward them along to the next steps of your intake process.

View More Features

They love FormDr - and so do their patients

  • “

    Not having an online custom form to offer patients was a huge struggle. FormDr makes paperwork seamless and saves a ton of time and money by allowing us to upload to patients EMR rather than print, fill out, scan, and then attach. That is now a hindrance of the PAST!

    Woodlands Dermatology
    Angela H.
  • “

    Patients can fill out the forms at their leisure, and don’t have to print anything. We’re collecting more completed forms than ever, and patients love not having to do anything when they come to the office for the first time.

    FYZICAL MetroWest
    Lauren A.
  • “

    FormDr allows me to send and receive attractive, professional forms from patients. Very helpful that I can remind patients of their appointment time and check the status of the form.

    Banks Hepatology Institute PC
    Alpha B.
  • “

    Sending a PDF was too time consuming for the patients to do, and it required the additional steps of printing and scanning it into our own systems. FormDr made it easier to get patients to complete the forms by email, and it’s a more secure way to provide info than simply emailing back a completed PDF.

    Reload Therapy
    Angie I.
  • “

    Before FormDr, the most common struggle were our patients taking a long time to complete forms in our office. Now patients are able to be seen faster when forms are completed prior to visit. Very easy service to create forms online!

    Skin Science Dermatology
    Courtney M.
  • “

    The support is second to none. FormDr has been instrumental in streamlining our intake of new patients.

    Lang Orthodontics
    Eric L.
  • “

    Before, clients weren’t signing our forms before the appointment. FormDr has allowed us to share our documents for client review and signatures. I really appreciate the support, it has been super helpful simplifying our forms!

    Meridian Behavioral Health
    Laura W.

Book a Free Consultation

FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who:

  • Are having patients fill out paper forms during the appointment
  • Are emailing patients a PDF or Word Doc to print out, fill out, scan, and send back
  • Are spending time manually printing and scanning paper forms

Schedule a consultation with us to learn more.