Online Intake

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Template Library

Access ready-to-use healthcare intake form templates for every specialty—from dental and primary care to mental health and physical therapy—all HIPAA compliant and fully customizable.

General - Financial Responsibility Form

General - Notice of Privacy Practices

General - Consent to Treatment

General - Telehealth Consent

General - Medical History Form

General - Cancelation Policy

Consent for AI Scribe Use

Dental - Medical and Dental Health History Form

Dental - Patient Information Form

Chiropractic - Intake Form

Dental - Financial Responsibility Form

General - Medical Records Release Authorization

Pediatrics - Refusal of Recommended Immunizations

Biopsychosocial Assessment Form

Counseling Intake Form

Medical - Insurance Verification Form

OB-GYN Patient History Form

Generalized Anxiety Disorder Assessment (GAD-7)

Patient Health Questionnaire (PHQ-9)

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

NICHQ Vanderbilt Assessment Scale

Vaccine Consent

Depression Anxiety Stress Scale - Youth (DASS-Y)

Depression Anxiety Stress Scale (DASS-21)

PTSD Checklist for DSM-5 (PCL-5)

Screen for Child Anxiety Related Disorders - Parent (SCARED)

Pittsburg Insomnia Rating Scale (PIRS-20)

Perceived Stress Scale (PSS-10)

Functional Analysis Screening Tool (FAST)

Short Michigan Alcohol Screening Test (SMAST)

Columbia-Suicide Severity Rating Scale (C-SSRS)

Suicide Behaviors Questionnaire (SBQ-R)

Michigan Alcohol Screener - Geriatric (MAST-G)

Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

The Tobacco, Alcohol, Prescription Medications, and Other Substance Tool (TAPS I & II)

Michigan Alcohol Screening Test (MAST)

Self-Administered Alcoholic Screening Test (SAAST-R)

Critical Outcomes in Routine Evaluation (CORE OM)

Clinical Outcomes in Routine Evaluation 10 (CORE-10)

Wender Utah Rating Scale (WURS)

Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL)

Hamilton Anxiety Rating Scale (HAM-A)

Perinatal Anxiety Screening Scale (PASS)

Zung Self-Rating Anxiety Scale (SAS)

Professional Quality of Life Scale (ProQOL)

Adverse Childhood Experience Questionnaire (ACE)

Epworth Sleepiness Scale (ESS)

International Prostate Symptom Score (I-PSS)

Medical Symptoms Questionnaire (MSQ)

Fatigue Severity Scale (FSS)

Foot and Ankle Disability Index (FADI)

Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)

Patient Satisfaction Survey

Lower Extremity Functional Scale (LEFS)

Pelvic Floor Impact Questionnaire (PFIQ-7)

AD8 Dementia Screening Interview

Patient Health Questionnaire – 2 (PHQ-2)

ADAM questionnaire about symptoms of low testosterone

Adult Brief Dissociative Experiences Scale–Modified (DES-B)

Advance Beneficiary Notice of Non-coverage (ABN)

Adverse Childhood Events Scale (ACES)

Adverse Childhood Experience Questionnaire for Adults (ACE-Adult)

Aging Male Symptoms Scale (AMS) Questionnaire

Alcohol Use Disorders Identification Test (AUDIT-C)

Altman Self-Rating Mania Scale (ASRM)

Appearance Anxiety Inventory (AAI)

Auditory Vocal Hallucination Rating Scale (AVHRS)

Autism Spectrum Quotient (AQ)

Autism Spectrum Quotient - 10 (AQ-10) (Adolescent)

Autism Spectrum Quotient - 10 (AQ-10) (Child)

Autism Spectrum Quotient - 10 (AQ-10) (Adult)

Autism Spectrum Screening Questionnaire (ASSQ)

Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)

Beck Depression Inventory (BDI)

Biopsychosocial Assessment

Berg Balance Scale (BBS)

Bipolar Depression Rating Scale (BDRS)

Clinical Opiate Withdrawal Scale (COWS)

Experiences in Close Relationships Scale - Revised (ECR-R)

Informed Consent - GLP-1 Agonist (Semaglutide and Tirzepatide)

Informed Consent - Male Testosterone Pellet Insertion

Liebowitz Social Anxiety Scale (LSAS)

Life Events Checklist - LEC-5

Menopause Rating Scale (MRS)

Neck Index

Revised Child Anxiety and Depression Scale - Child version (RCADS-Child)

Subjective Opiate Withdrawal Scale (SOWS)

Upper Extremity Function Scale (UEFS)

Quick DASH

PCL-S - PTSD Checklist - Specific

Upper Extremity Functional Index (UEFI)

Yale Brown Obsessive-Compulsive Scale (YBOCS)

Brief Biosocial Gambling Screen (BBGS)

Modified Checklist for Autism in Toddlers (M-CHAT)

Sport Concussion Assessment Tool 2 (SCAT 2)

ABCD3-1 / ABCD2 Stroke Risk Assessment Tools

Body Perception Questionnaire Autonomic Symptoms Short Form (BPQ-20 ANS)

Supplemental Appendix A: The IBS-QOL Questionnaire

The Alcohol Use Disorders Identification Test (AUDIT)

Drug Abuse Screening Test (DAST-10)

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