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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.
Setup a Patient Intake Form
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.

Discover More Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
White Labeled HIPAA Compliant Forms

White Labeled Accounts

Have your account match your company branding with FormDr White Labeled Enterprise. Create a customized, branded look without having to build your own HIPAA compliant online form software.

square payment processing icon

Square Payment Processing

Quickly and efficiently collect patient payments using a HIPAA-compliant payment processing widget with reporting capabilities and the easy customizations you expect from FormDr.

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.

Drawing and Diagrams

Drawing 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.

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They love FormDoctor - and so do their patients

  • “

    Not having an online custom form to offer patients was a huge struggle. FormDoctor 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.
  • “

    FormDoctor 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. FormDoctor 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 FormDoctor, 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. FormDoctor has been instrumental in streamlining our intake of new patients.

    Lang Orthodontics
    Eric L.
  • “

    Before, clients weren’t signing our forms before the appointment. FormDoctor 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