Online Intake

Form Templates

Easily send and receive your intake forms online. Send clients your online intake forms to fill out on their phone, tablet, or computer. Clients securely sign and submit completed intake forms. Track the progress of new patient intake forms, send automated reminders, and receive completed forms online.
HIPAA PolicyConsent to TreatmentPatient Registration

Template Library

Unlock efficiency and enhance patient care with our extensive template library for streamlined digital forms.
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General - Financial Responsibility Form
Dental
Medical
Mental Health
Optometry
Ensure clarity and transparency in financial matters by using our Financial Responsibility form
General - Notice of Privacy Practices
Dental
Medical
Mental Health
Optometry
Law
Establish trust and maintain confidentiality by providing patients with a clear understanding of how their protected health information is handled
General - Consent to Treatment
Dental
Medical
Mental Health
Optometry
Actively involve patients in the decision-making process by obtaining informed consent
General - Telehealth Consent
Medical
Mental Health
Optometry
Dental
Promote compliance with regulatory requirements and facilitating secure and convenient virtual healthcare
General - Medical History Form
Medical
Mental Health
Efficiently collect and review patients' past medical information, aiding in comprehensive assessments, accurate diagnoses, and personalized treatment plans
General - Cancelation Policy
Medical
Dental
Mental Health
Optometry
Discover how a well-crafted cancellation policy creates better outcomes for healthcare providers and patients alike. Our comprehensive guide includes a ready-to-use template, essential policy components, and implementation strategies.
Dental - Records Release Form
Dental
Authorizes the secure release of dental records for treatment, insurance, or personal use.
Chiropractic - Intake Form
Chiropractic
Easily collect information from new patients with this form template.
Dental - Financial Responsibility Form
Dental
Outlines a patient’s payment obligations to reduce billing disputes and ensure financial transparency.
General - Medical Records Release Authorization
Medical
Optometry
Dental
Mental Health
Ensure seamless and secure information exchange between healthcare providers
Pediatrics - Refusal of Recommended Immunizations
Pediatrics
Documents a parent’s informed refusal of vaccines to reduce liability and support clear communication.
Biopsychosocial Assessment Form
Mental Health
Comprehensive Patient Evaluation Tool for Mental Health and Integrated Care Settings
Medical - Insurance Verification Form
Medical
Confirms patient insurance coverage and benefits to ensure accurate billing and reduce claim denials.
OB-GYN Patient History Form
Medical
Collects essential reproductive and medical history to guide OB-GYN care and support patient wellness.
Generalized Anxiety Disorder Assessment (GAD-7)
Mental Health
Medical
Screens for anxiety symptoms with a quick, validated 7-question assessment used in primary and mental health care.
Patient Health Questionnaire (PHQ-9)
Medical
Mental Health
Evaluate and track the severity of depressive symptoms in patients, enabling more accurate diagnoses and guiding personalized treatment.
Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
Mental Health
The Adult ADHD Self-Report Scale (ASRS v1.1) is an 18-item tool for adults 18+ to screen for ADHD symptoms and aid in diagnosis, best used with a clinical interview.
NICHQ Vanderbilt Assessment Scale
Pediatrics
NICHQ Vanderbilt Assessment Scales: Use these tools to evaluate ADHD and behavioral symptoms in children, gathering insights from parents and teachers for a well-rounded diagnosis.
Foot and Ankle Disability Index (FADI)
Medical
Physical Therapy
Evidence-Based Outcome Measurement Tool for Foot and Ankle Conditions
The Alcohol Use Disorders Identification Test (AUDIT)
Medical
Screens for risky alcohol use to guide brief interventions and treatment referrals.
Drug Abuse Screening Test (DAST-10)
Medical
Mental Health
Screens for drug misuse to identify risk levels and guide early intervention or treatment referrals.
Patient Health Questionnaire - Modified for Teens (PHQ-A)
Medical
Mental Health
Pediatrics
Screens teens for depression to support early intervention, treatment, and improved mental health outcomes.
Pediatric Symptom Checklist (PSC-17)
Medical
Pediatrics
Screens for behavioral and emotional issues in children to guide early intervention and referrals.
Edinburgh Postnatal Depression Scale (EPDS)
Medical
Screens for postpartum depression to support early detection, treatment, and maternal-infant health.
The Disabilities of the Arm, Shoulder and Hand (DASH)
Physical Therapy
Measures upper limb disability and symptoms to track recovery and support treatment decisions.
Oswestry Low Back Pain Disability Questionnaire
Chiropractic
Physical Therapy
Assesses how low back pain affects daily function to track progress and guide care.

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