Intake Form Template

Contact, health history and consent for new patients

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intake forms

What is a patient intake form?


If you are a healthcare practitioner, having your patients/clients fill out intake forms, aka health history forms, is required by law in most states and provinces. Intake forms also help you better serve your clients by gathering important health history information to help you build more effective treatment plans.

customizable forms

Download the free patient intake form template now!

What kind of information is included in a health history form?

A health history form allows practitioners and therapists to gather important information about their clients or patients that help guide the treatment plan. These forms include items such as contact information, health history, covid screening information, their reason for visiting, written content forms, and more.

  • Contact information

    You need up-to-date contact information for your clients. There may be times when you need to get in touch with them about an appointment or share news about your business.


  • COVID-19 Pre-screening

    You can’t afford to get sick and be forced to take off work. You also can’t risk the health and safety of your clients. Take proper precautions to prevent people from entering your clinic when they are ill or contagious. Have your clients complete a pre-screening before their appointment.


  • Consent

    Get your clients permission to treat them by requiring a signature at the bottom of your intake form. Briefly describe what they are agreeing to, just to make sure everyone is on the same page.


  • Health history

    It’s important to know what your client’s current health status is, as well as health issues they have experienced previously. This information may impact your treatment strategy and the effectiveness of your strategy. Even if you offer massage purely for relaxation, you need to find out if your client has any conditions that are contraindicated.


  • Reason for appointment

    Even when a client shares a lot of information about themselves, don’t assume you know why they came to see you. Ask them directly. A successful treatment plan depends on the answer to that question.



How do you create a patient intake form online?

You can build new patient intake forms online with practice management tools like ClinicSense. ClinicSense offers customizable and HIPAA and PIPEDA-compliant solutions that allow practitioners to save time, streamline their business, and overcome the frustrations of managing paperwork! ClinicSense is used by massage therapists, occupational therapists, physical therapists, multidisciplinary clinics, and more!


intake forms

With online clinic intake forms, you can:

  • Automatically send forms when clients book
  • Save up to 75% on admin time and tasks
  • Stay HIPAA and PIPEDA compliant
  • Build out customizable forms
  • Save time with pre-built forms and templates.
  • Stay organized online
  • Say goodbye to paperwork
  • Plan treatments ahead
  • Store client health history in one place
  • Gather consent and signature digitally
  • And more!

Why should I use online intake forms?

Online patient intake forms give time back to both clients and practitioners. With online forms, new patients can fill out their client intake forms before their appointment - from home - at a time that's convenient for them. This saves them from wasting valuable treatment time filling out paperwork and empowering practitioners to provide better treatment by planning ahead.


If you want to reduce paperwork, increase compliance, and save time on admin work, you should consider using online patient intake forms with ClinicSense. Learn more to read about everything our customizable intake form solution provides!

Make an online consent form

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