Patient Intake
Form Template

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

Patient Intake Form Template

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

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

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What is included in the Patient Intake Form Template?

01Patient Information

Your patient 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. 

02Questionnaire

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.

03Privacy Practices and Consent Forms

This Patient 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!

04Autocompleted Fields

Are you asking your patients the same questions on multiple forms? Give your patients the ability to fill out their information once and have it populate throughout all of your forms. Automatically populate fields and paragraphs of text with information that has been inputted previously by the patient. 

05Conditional Logic

Only show information that is relevant to the patient with conditional logic. Make it simple for your patients to complete your forms and improve the accuracy of the data you receive with conditional logic.

06Save And Continue Later

Allow patients to save their progress on larger forms and packets. Patients will be able to resume where they left off and finish completing your forms at a later time.

07Signature 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.

Why Online Patient Intake Forms?

Streamline your intake forms online. Automate your new patient paperwork. Start saving time and money.
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.

HIPAA Compliant Online Intake Form Packets

Intake Form Packets

Combine multiple pages into an online form packet. Have your patients fill out their medical history, consent to treat, and demographics all in one new patient intake form packet.

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 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.

Card Photo Uploads

Card Photo Uploads

Have your patient take a picture of their insurance and ID cards. New patients will automatically upload a photo of their card information, so you can verify it before the appointment.

Autocomplete HIPAA Compliant Forms

Autocomplete Forms

Have your patient enter information once and have it autocomplete throughout your medical form online. Automatically populate PHI directly into additional fields and medical consent forms.

HIPAA Compliant Form Submissions

HIPAA Compliant Form Submissions

Patients sign and submit forms securely to your online account. Review and manage completed patient forms before the appointment.

Conditional Logic

Conditional Logic Forms

Only show information that is relevant to the patient with conditional logic forms. Make it simple for your patients to complete your forms and improve the accuracy of the data you receive with conditional logic.

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.
Schedule a consultation with us to learn more

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