Here are some sample patient intake forms – feel free to edit them and customize them for your specialty.
Free Patient Intake Form Template
In general, if you can, try to get the patient to answer most of these questions (demographics, insurance, clinical history and chief complaint).
In any case, your patient will need to give you all this data while in your waiting room. Try to have the patient fill these out in the comfort of their homes (as these do take a good 15-20 mins to fill out). This way, when the patient comes in, they are fully prepared with the correct information.
Unfortunately, unless you use digital patient intake forms, you do have to type all this information into your EMR or scan and upload the PDF into the patient chart.
The clinical, family, social histories and the chief complaint information truly cuts down on the time it takes techs to work up a patient. It’s the same information that is captured and transferred over whether the patient types it in or if the tech asks the patient those questions and enters the information into the EMR.
- Patient demographics data
- Patient’s social & clinical history, medication list.
- Insurance details of the patient (or whether they are a self pay) along with insurance card details
Free Patient privacy notices consent forms
Feel free to use these privacy practices notice that we all have to use at our front desk.
Free Patient Health Insurance Billing Consent Form Template
Feel free to use these Health Insurance Billing Consent notice that we all have to use at our front desks.
Free Patient Consent Form For Electronic Communications Template
Feel free to use these Patient Consent Form For Electronic Communications notice that we all have to use at our front desk.
Free Patient Consent For Use of Electronic Prescription Information Template
Feel free to use these Free Patient Consent For Use of Electronic Prescription Information notice that we all have to use at our front desk.