Online Intake

Form Templates

Unlock efficiency and enhance patient care with our extensive template library for streamlined digital forms. HIPAA-compliant and ready to use.

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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 — Patient Informed Consent Form

Dental Medical and Health History Form — New Patient Clinical Record

Dental Patient Information Form — New Patient Registration

Chiropractic Intake Form — New Patient History & Assessment

Dental Financial Responsibility Form — Patient Payment Policy Agreement

General - Medical Records Release Authorization

Pediatrics - Refusal of Recommended Immunizations

Biopsychosocial Assessment Form — Structured Mental Health Intake | Zentake

Counseling Intake Form — New Patient Mental Health Assessment

Medical - Insurance Verification Form

OB-GYN Patient History Form

Generalized Anxiety Disorder Assessment (GAD-7)

Patient Health Questionnaire (PHQ-9)

ASRS-v1.1 Adult ADHD Screener — Self-Report Scale | Zentake

NICHQ Vanderbilt Assessment Scale

Vaccine Consent

DASS-Y Depression Anxiety Stress Scale Youth — Child & Adolescent Screening Tool

DASS-21 Depression Anxiety Stress Scales — Digital Assessment Tool

PTSD Checklist for DSM-5 (PCL-5)

SCARED Parent Form — Digital Anxiety Screening Tool

Pittsburg Insomnia Rating Scale (PIRS-20)

Perceived Stress Scale (PSS-10)

Functional Analysis Screening Tool (FAST)

Short Michigan Alcohol Screening Test (SMAST)

C-SSRS Suicide Risk Assessment — Columbia Protocol Digital Tool

Suicide Behaviors Questionnaire (SBQ-R)

Michigan Alcohol Screener - Geriatric (MAST-G)

CIWA-Ar Alcohol Withdrawal Scale — Digital Assessment Tool

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

Michigan Alcohol Screening Test (MAST)

Self-Administered Alcoholic Screening Test (SAAST-R)

CORE-OM Outcome Measure — 34-Item Therapy Progress Assessment

CORE-10 Psychological Distress Measure — Digital Outcome Tool

Wender Utah Rating Scale (WURS)

DBT-WCCL — Dialectical Behavior Therapy Ways of Coping Checklist

Hamilton Anxiety Rating Scale (HAM-A)

Perinatal Anxiety Screening Scale (PASS)

Zung Self-Rating Anxiety Scale (SAS)

Professional Quality of Life Scale (ProQOL)

ACE Questionnaire — Adverse Childhood Experiences Screening Tool | Zentake

Epworth Sleepiness Scale (ESS) — Daytime Sleepiness Screening Tool

International Prostate Symptom Score (I-PSS)

Medical Symptoms Questionnaire (MSQ)

FSS Fatigue Severity Scale — 9-Item Fatigue Assessment Tool

FADI Foot and Ankle Disability Index — Function & Pain Assessment

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 — Digital Cognitive Assessment | Zentake

Patient Health Questionnaire – 2 (PHQ-2)

ADAM Questionnaire — Low Testosterone Screening Tool | Zentake

DES-B Dissociation Scale — Brief Dissociative Experiences Assessment | Zentake

Advance Beneficiary Notice of Non-Coverage (ABN) — Medicare Financial Liability Form

ACE Questionnaire — Adverse Childhood Experiences Screening Tool | Zentake

ACE-Adult Questionnaire — Adverse Childhood Experiences for Adults | Zentake

AMS Questionnaire — Aging Males' Symptoms Scale | Zentake

AUDIT-C Alcohol Screening — Hazardous Drinking Assessment Tool

ASRM Mania Scale — Altman Self-Rating Mania Screening Tool

AAI Appearance Anxiety Inventory — Body Dysmorphic Disorder Screening Tool

AVHRS Auditory Vocal Hallucination Rating Scale — Digital Voice Hearing Assessment

AQ Autism Spectrum Quotient — 50-Item Autistic Traits Self-Assessment | Zentake

AQ-10 Adolescent Autism Screening — 10-Item Spectrum Quotient for Ages 12–15 | Zentake

AQ-10 Child Autism Screening — 10-Item Parent-Report Screener for Ages 4–11 | Zentake

AQ-10 Adult Autism Screening — 10-Item Spectrum Quotient Self-Assessment | Zentake

ASSQ Autism Screening Questionnaire — 27-Item Parent/Teacher Rating Scale for Ages 6–17 | Zentake

BASDAI Ankylosing Spondylitis Scale — Disease Activity Index

BDI-II Beck Depression Inventory — Depression Severity Screening

Biopsychosocial Assessment — Comprehensive Clinical Intake Tool | Zentake

Berg Balance Scale (BBS) — Fall Risk & Balance Assessment | Zentake

BDRS Bipolar Depression Rating Scale — Clinician-Rated Depression Assessment | Zentake

CARS-2 Questions for Parents: Childhood Autism Rating Scale Caregiver Form

Bournemouth Questionnaire — Back Pain Outcome Measure

Adult Attachment Questionnaire (AAQ) — Attachment Style Assessment

COWS Opiate Withdrawal Scale — Digital Assessment Tool

MSI-BPD Borderline Personality Disorder Screening — McLean Screening Instrument | Zentake

CUPIT Cannabis Screening — Cannabis Use Problems Identification Test | Zentake

CES-DC: Center for Epidemiological Studies Depression Scale for Children

ECR-R Attachment Scale — Experiences in Close Relationships Revised

Geriatric Depression Scale - 15

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

SF-12 Health Survey — Quality of Life Assessment Tool

ABS Agitated Behavior Scale — TBI Agitation Assessment Tool

ALSFRS-R ALS Functional Rating Scale — Disease Progression Assessment

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