Patient Intake Form with Examples

This patient intake form template is created by a nurse to help make medical patient intakes easier. It generally covers their personal information, medical history, current health concerns, primary care provider details, and insurance and billing information, among others. Using this template in Heidi, the AI medical scribe for all clinicians, you can easily:

A patient intake form, also known as a medical intake form, is used to gather essential information from patients prior to appointments, to help doctors prepare. It typically includes the patient’s medical history, symptoms, and personal, as well as their insurance information or funding method in order to streamline medical care.

In this article, we’ll talk about what makes a comprehensive patient intake form, the importance of using high-quality patient intake forms in your medical practice, as well as provide ready-to-use patient intake form templates that you can use and modify to your practice setting.

A high-quality medical patient intake form is essential to all medical practices for the following reasons:

Boosts Efficiency and Accuracy – Doctors have always been some of the busiest professionals, and good patient intake forms can help them save time by collecting important patient information in advance to reduce errors, and streamline appointment management.

Improves Patient Care – Having a form that provides them with a clear medical history and detailed symptoms per patient ensures that doctors can provide well-informed and bespoke care; boosting the chances of successful treatment.

Simplifies Billing and Compliance – Patient intake forms also aid with the smooth processing of claims and benefits. Additionally, it covers the necessary legal forms to secure compliance with relevant laws, minimizing administrative disputes.

While patients typically trust their doctors' expertise, legal issues can arise if informed consent is not adequately implemented before or during the course of treatment. In addition, how their data is going to be used in the course of providing them care, this is typically contained in privacy policies and other terms that may be contained in the intake form.

Informed consent refers to the legal and ethical responsibility of healthcare professionals to ensure patients fully comprehend and can agree to the planned use of their personal medical information and health data, they can be reassured that confidentiality is preserved amongst the practising team and whoever that contains and that they can understand any suggested medical procedures and treatment plans before undergoing them.

In the context of new patient intake forms, informed consent also means ensuring patients grasp the information they are providing to their doctor, as well as how that information will be used to inform their treatment.

To ensure that healthcare providers comply with these legal and ethical requirements, their medical intake forms must be written in clear, simple language free of medical and legal jargon.

For example, instead of saying “comorbidities”, doctors can simply say “other health conditions.” Using simple, common language in both patient intake forms and over the course of treatment helps ensure patients understand what they are reading and signing; minimizing the chances of legal and ethical issues arising.

Beyond informed consent, medical practitioners must also ensure that their patient intake forms comply with privacy regulations like HIPAA which were enacted to protect sensitive patient information. We've added example sections for regulations spanning across the US, UK, EU, CA, AU, and NZ in our example, pick whatever is relevant to your jurisdiction.

Ultimately, by prioritizing clear communication and adhering to legal guidelines, medical professionals can ensure their patient intake form templates are both effective in streamlining their practice, and compliant.

An effective patient intake form must request the following information to ensure that the attending doctor is adequately briefed prior to the appointment, and that all legal and ethical obligations have been fulfilled prior to and during the course of treatment:

Personal Information – The patient’s full name, date of birth, sex, home address, phone number, and email.

Emergency Contact Details – Name, relationship, and active phone number of a designated emergency contact.

Medical History – Past illnesses, surgeries, known allergies, medications currently being taken, and chronic conditions.

Lifestyle and Social History – Smoking, alcohol and drug consumption, exercise habits, and occupational health risks.

Present Health Concerns – This is where the patient explains the reason for their visit in as much detail as possible, including symptoms, and any recent health changes.

Primary Care Physician and Referral Information – The details of the patient’s primary care doctor, and any referring providers.

Insurance and Billing Information – The patient’s insurance number(s), policy number(s), and details of their payment responsibility. This might vary per insurance provider if the patient has several.

Consent and Authorization – The patient’s signed agreements for the proposed treatment plan.

This is where the health care providers, in accordance with the law of informed consent, must ensure that the details, risks, side-effects, and other implications are clearly and fully understood by the patient prior to giving their consent.

This section also covers the terms for data privacy such as HIPAA compliance with any relevant privacy policy and data processing agreements if required.

We’ve built a medical patient intake form as an example. You can copy the doc and edit the relevant sections to customize for your own usage.

While patient intake forms are essential to the operation of medical practices, manually processing and compiling patient intake forms is time-consuming and inefficient for both patients and medical staff.

For example, handwriting varies greatly from one patient to the next, and in some instances, patients might be asked to redo their forms, contributing to an increase in paper waste in addition to lost time.

In today’s AI-driven world, digital patient intake forms can eliminate the administrative pains of manual form filling through a highly-accurate, AI medical scribe like Heidi.

For example, New Zealand-based psychiatrist Dr. Tony Fernando now saves at least 2 hours per day on documentation and note-taking thanks to Heidi’s AI medical scribe; and the same powerful software can be used to collect patient information via customizable, online patient intake forms.

Heidi collects and organizes your patient intake forms for you, allowing you to dedicate more time and energy to high-quality patient care instead of paperwork. Heidi helps in three simple steps:

Heidi is compliant around the world, including HIPAA, GDPR, ISO, among other data privacy, security standards and regulations. Currently, over 100,000 healthcare professionals globally trust Heidi to streamline their day-to-day practices.

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This inpatient intake note template is designed to help psychiatrists capture detailed patient information upon admission to an inpatient facility. It records the patient's psychiatric history, current medications, substance use, social and family history, as well as details from a mental status examination.‍

This new patient intake form covers psychiatric and medical history, current symptoms, past treatments, and other social factors essential for accurate diagnosis. It also enables an in-depth initial patient evaluation to aid accurate diagnosis and treatment planning.

This medical history intake form serves as a detailed assessment template for dieticians to document the client’s weight and eating history, current nutrition, activity levels, and other relevant lifestyle factors that can help inform a personalized wellness plan.

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It’s generally advisable to update patient intake forms at least once a year. Regularly updating intake forms is essential for delivering more effective, personalized care. Significant life events such as major health changes or changes in lifestyle, medication, and family medical history could also affect the frequency, among other factors.

As an AI medical scribe, Heidi simplifies patient intake. Instead of manual notation, patients talk about their medical history, and Heidi automatically populates the necessary fields, ensuring complete and accurate documentation. This eliminates the hassles of illegible handwriting, missing information, and manual filing, saving valuable time for everyone.

Absolutely! Heidi allows you to select from pre-built, ready-to-use templates, but you can also customize them to suit your practice’s specific needs. Additionally, you can upload a sample note or patient intake form with your preferred format and automatically convert it into an editable, AI-enabled intake template within Heidi.