Patient intake form template

Make it more human—but also keep it time-efficient. This patient intake form template shows you how to make a form feel like a conversation. By asking one question at a time, you help your patients focus.

It’ll help them give thought-through answers and leaves little room for confusion. And things like recalling their name in follow-up questions makes the whole process feel more personal. A little goes a long way.

We hear you. Let’s start by cutting out the copy-pasting data from paper forms or PDFs into spreadsheets or patient files. Our smart integrations will automate this for you.

Like magic, all the data will appear in the right place—so you can focus on other tasks. You can automatically create Google Docs, store responses neatly in Dropbox. Any follow-up forms needed based on a patient's questions? We can arrange that as well.

Before you send out your form, there are two things you should do:

1. Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

1. Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.