Patient Intake Form Template
Free, customizable patient intake forms for your medical practice. Download templates that capture all essential information—demographics, insurance, medical history, and consent.
What is a Patient Intake Form?
A patient intake form is a document that collects essential information about a patient before their first visit to a healthcare provider. It serves as the foundation of the patient's medical record and helps clinicians deliver safe, informed care.
Also called a new patient form, registration form, or client intake form, this document captures demographics, medical history, insurance information, and required legal consents—everything your practice needs to begin a care relationship.
Why Patient Intake Forms Matter
Essential Patient Intake Form Sections
A comprehensive intake form includes these 8 key sections. Each captures critical information for delivering safe, effective care.
Patient Demographics
Basic identifying information about the patient
- Full legal name
- Date of birth
- Social Security Number (optional)
- Gender/Sex
- Preferred pronouns
- +5 more fields
Emergency Contact
Who to contact in case of emergency
- Contact name
- Relationship to patient
- Phone number(s)
- Address (optional)
- Alternative emergency contact
Insurance Information
Health insurance coverage details
- Insurance company name
- Policy/Member ID number
- Group number
- Policyholder name
- Policyholder DOB
- +4 more fields
Medical History
Current and past health conditions
- Current medical conditions
- Past medical conditions
- Previous surgeries/hospitalizations
- Known allergies (medications, food, environmental)
- Current medications (name, dose, frequency)
- +2 more fields
Family History
Health conditions in immediate family
- Heart disease
- Diabetes
- Cancer (specify type)
- High blood pressure
- Mental health conditions
- +3 more fields
Social History
Lifestyle and social factors
- Occupation
- Marital status
- Living situation
- Tobacco use (current/former/never)
- Alcohol use (frequency/amount)
- +3 more fields
Reason for Visit
Current health concerns
- Chief complaint
- When symptoms started
- Symptom severity (1-10)
- What makes it better/worse
- Previous treatment for this issue
- +1 more fields
Consent & Acknowledgments
Legal consents and signatures
- Consent to treatment
- HIPAA privacy notice acknowledgment
- Financial responsibility agreement
- Authorization for insurance billing
- Release of information consent
- +1 more fields
Specialty-Specific Intake Forms
Different specialties require additional information beyond the standard intake form. Here's what to add for common specialties.
Primary Care
Template AvailableMental Health
Template AvailablePediatrics
Template AvailableOB/GYN
Template AvailableOrthopedics
Template AvailableDermatology
Template AvailableDigital vs Paper Intake Forms
More practices are moving to digital intake forms. Here's how they compare.
| Aspect | Digital Forms | Paper Forms |
|---|---|---|
| Data Accuracy | Built-in validation reduces errors; required fields ensure completeness | Handwriting may be illegible; fields can be skipped |
| Staff Time | Auto-populates EHR; minimal data entry needed | Requires manual data entry; 10-15 min per form |
| Patient Experience | Can complete at home before visit; faster check-in | Must arrive early; longer wait times |
| Storage | Cloud-based; no physical storage needed | Requires filing space; scanning for EHR |
| Compliance | Automatic audit trails; timestamped signatures | Manual tracking; signature verification challenges |
| Cost | Software subscription; reduces printing costs | Ongoing printing/paper costs; staff time |
Patient Intake Form Best Practices
Keep It Concise
Only ask for information you'll actually use. Long forms lead to incomplete responses and patient frustration. If a field isn't essential for the first visit, consider collecting it later.
Use Clear Language
Avoid medical jargon. Instead of "hypertension," ask about "high blood pressure." Include examples where helpful. Consider literacy levels and offer forms in multiple languages.
Send Forms in Advance
Email or text intake forms 24-48 hours before the appointment. Patients can take their time, look up medication names, and arrive prepared—reducing wait times for everyone.
Include HIPAA Notice
The HIPAA Privacy Rule requires you to provide patients with a Notice of Privacy Practices. Include acknowledgment signature on your intake form to document compliance.
Verify Insurance Every Visit
Insurance changes frequently. Ask patients to confirm their coverage at each visit, even if they've been seen before. This prevents billing surprises for both parties.
Integrate with Your EHR
Digital intake forms that feed directly into your EHR eliminate double data entry, reduce errors, and ensure information is immediately available to clinicians.
Download Free Intake Form Templates
Get started with our professionally designed patient intake forms. Print-ready HTML templates you can customize.
Demographics, insurance, medical history, consent
Comprehensive health conditions, medications, allergies
Privacy practices notice and patient acknowledgment
General consent for medical examination and treatment
Open templates in browser, then use File > Print > Save as PDF to download.
Or skip the paperwork entirely with PatientNotes digital intake—patients complete forms online, and data flows directly to your notes.
Try Digital Intake Free7-day free trial • No credit card required • HIPAA compliant
Frequently Asked Questions
What should be included in a patient intake form?
A comprehensive patient intake form should include: patient demographics (name, DOB, address, contact info), emergency contact information, insurance details, medical history (current conditions, past surgeries, allergies), current medications, family history, social history, reason for visit, and consent/HIPAA acknowledgment signatures.
How long should a patient intake form be?
Patient intake forms typically range from 2-6 pages depending on specialty. Primary care forms tend to be longer (4-6 pages) to capture comprehensive history, while specialty practices may use shorter, focused forms (2-3 pages) supplemented by specialty-specific questionnaires.
Can patient intake forms be completed digitally?
Yes, digital patient intake forms are increasingly common and preferred. They can be completed via patient portal, tablet in-office, or emailed links before appointments. Digital forms reduce data entry errors, save staff time, and integrate directly with EHR systems.
Are patient intake forms required by law?
While intake forms themselves are not legally mandated, certain elements are required: HIPAA Notice of Privacy Practices acknowledgment, informed consent for treatment, and insurance authorization. Medical practices are also required to maintain accurate patient records, which intake forms help establish.
How often should patient intake forms be updated?
Best practice is to have patients review and update their intake information annually, or whenever there are significant changes (new insurance, new medications, new diagnoses). Many practices ask patients to verify demographics and insurance at each visit.
Streamline Your Entire Documentation Workflow
PatientNotes handles intake forms, visit notes, and more—all in one HIPAA-compliant platform.
Start Free Trial