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Dental Intake Form Template

Easily send and receive your dental intake forms online. Send patients your online dental 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 online 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 secure 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, NHS 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 secure online forms. Streamline your process of collecting information.
HIPAA Compliant File Upload

File Attachment Upload

With file upload fields, your customers, clients, or patients can easily upload documents, pictures, and other items with their online form.

HIPAA Compliant Electronic Signatures

Electronic Signatures

Easily collect electronic signatures from customers, clients, and patients. Anyone can digitally sign from their phone, tablet, or computer.

HIPAA Compliant Tablet Forms

Forms on iPads or Tablets

Give customers, clients, or patients the option to sign and complete online forms with an iPad or tablet. Online forms work on all tablets, regardless of operating system.

Mobile Friendly Forms

Mobile-Friendly Forms

Build fully-responsive online forms that allow your customers, clients, and patients to sign and submit on any device, anywhere, at any time.

View More Features

Build an online dental intake form for free

Start saving time and money with FormDr

Try Dental Intake Forms Free for 14 Days

Create your dental intake forms with our easy to use online form builder, no credit card required! Or schedule a call today and let us convert your dental files to online forms for you.

Introductory Price

14 Day Free Trial
£19/ MO
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  • Unlimited Forms
  • Unlimited Total Submission Storage
  • 1 User
  • 1 Packet
  • Secure Online Forms
  • Live Webinars & Email Support
  • Embed Forms on Website
  • Text (SMS) Invitations
  • Email Invitations
  • Forms on iPad & Tablet

  • Required Fields
  • Card Photo Uploads
  • Electronic Signatures
  • Appointment Reminders
  • Submission Progress Tracking
  • PDF & CSV Export 
  • Conditional Logic Fields
  • Customize with Your Logo & Branding
  • GDPR Compliant
  • No Contracts, Cancel Anytime

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FormDr gives you everything you need to easily send and receive Secure GPDR compliant forms and documents. We help businesses and practices that:

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