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Optometry Intake Form Template

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

Optometry Intake Form Template

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

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

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What is included in the Optometry Intake Form Template?

01Patient Information

Your optometry 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. 

02Health 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. 

03Questionnaire

This patient questionnaire will help you assess the purpose of the patient’s visit. It also collects other important information relating to the visit, including medication information and substance abuse history.

04Privacy Practices and Consent Forms

This Optometry Intake Form Template packet has included a notice of privacy practices as well as an informed consent form. Cover all of your bases in one simple location!

05Signature and Date

Have your patients e-sign and date the authorization form. Completed medical records release forms will be submitted directly to your account online. Review authorization of record release forms online.

06HIPAA Compliant Online Intake Forms

Emailing new patient intake forms risks the interception of PHI. FormDr is HIPAA compliant, all patient data is encrypted in transit and rest. A Business Associate Agreement is included with your account.

07Custom Logo, Brand, And Styling

Add your logo to your forms and set the colors to match your brand. Pick the background of your forms, customize the gradient of your buttons, and select the field text color.

Discover More Form Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
HIPAA Compliant Form Builder

HIPAA Compliant Form Builder

Easily build HIPAA compliant online forms. No coding is required to create secure online intake forms for your patients. All patient form submissions are encrypted in transit and rest. A Business Associate Agreement is included with your service.

Print HIPAA Compliant Submissions

Print HIPAA Compliant Form Submissions

Print your patients’ submissions after the forms have been completed online. Adjust the formatting and text size to match your original paper forms.

HIPAA Compliant Form Kiosk

Kiosk Form Page

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

Required HIPAA Compliant Form Fields

Required Form Fields

Always get the information you need with required fields. Patients can only submit when they complete all of your required fields. Never receive an incomplete medical form again.

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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.

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FormDr gives your practice everything needed to easily send and receive HIPAA compliant online forms. 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