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.
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.
Mobile Friendly Forms

Mobile-Friendly Forms

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

Custom Logo and Branding

Custom 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.

Export to Excel

Export Form Submissions to Excel

Export multiple patient forms into a Microsoft Excel compatible CSV file. Take control of your patient data with a bulk export, and import your complete patient forms into a database, excel spreadsheet, or EHR.

Prefilled HIPAA Compliant Forms

Prefilled Forms

Send a prefilled contracts, agreements, and forms to have patients securely sign forms customized for them. Create financial contracts with pricing specific to the patient.

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  • 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 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