The Intake

Insights for those starting, managing, and growing independent healthcare practices

How to create the perfect medical intake form for patients

Dive into the art and science of crafting the ideal medical intake form, from understanding core essentials to leveraging digital templates for optimal patient engagement.

Healthcare practice owner creates medical intake form template on computer

At a Glance

  • Medical intake forms for new patients should collect essential identifying information, reasons for visiting, medical history, insurance details, and more, while forms for returning patients can be condensed.
  • Intake forms should be accessible in both electronic and paper formats to accommodate different patients’ needs, with considerations for font size, internet access, language barriers, and disabilities.
  • Well-designed intake forms can improve the patient experience while still collecting the necessary information a practice requires.

Although medical intake forms are necessary for all practices, few people enjoy filling them out. So, how do you make things easier on your patients and potentially improve how they experience the initial part of their visit? Create the perfect patient intake form — or, ideally, forms.

To make things as easy as possible for your patients, you should have 2 types of patient intake forms: one for new and the other for established patients. There are also portions of forms that are negotiable and others that aren’t. After all, a patient’s family medical history doesn’t change. However, they may need to add additional information at some point in the future.

So, how do you create an effective intake form? Let’s look at what information needs to be on your new patient intake form template and how you can significantly shorten what data is asked of established patients.

Patient Perspectives Report

What should be included in a patient intake form?

There is almost always a grimace or a groan, audible or not, that patients give when handed a packet of information to complete. Letting patients know that this is the only time they have to fill in these blanks will alleviate some of that angst.

You can also tell them that they will review an abbreviated form for established patients in the future. This condensed medical intake form will allow them to verify their existing information is accurate and correct or update what your office has on file, which will reduce a portion of resistance to required form completion.

Essential personal identifying information

Many of these crucial elements are consistent in most forms we encounter in our everyday lives. As you create your new patient intake form template, make sure to include these fields:

  • Full legal name: _____________________________________
  • Name you want to be used during communications and visits with this office: ___________
  • Personal pronoun by which you prefer to be addressed (i.e., he/him, she/her, they/them, other _______ )
  • Date of birth: ___________________
  • Social Security number: ___________________________
  • Physical address: ________________________________________
  • Mailing address: ________________________________________
  • Email address: __________________________________________
  • Primary phone number: __________________________________
  • Secondary phone number: ________________________________
  • Emergency contact name and phone number: __________________________
  • What is your emergency contact’s relationship to you? ___________________

Gender identification and sexual orientation

Many online systems still need to catch up with how people prefer to identify themselves. Therefore, before creating your medical intake form template, learn about any systematic constraints of adding fields or a comment box to capture patient preferences.

Before creating your medical intake form template, learn about any systematic constraints of adding fields or a comment box to capture patient preferences. ”

Because this can be a topic some don’t understand, the CDC suggests the following approach. 

Additionally, Dr. Drew Sutton, MD, pointed out and suggested adding, “Without the following information, lesbian, gay, bisexual, and transgender (LGBT) patients and their specific healthcare needs cannot be identified, the health disparities they experience cannot be addressed, and important healthcare services may not be delivered.”

What gender were you assigned on your birth certificate at birth?

  • Female
  • Male
  • Decline to answer

Do you think of yourself as:

  • Female
  • Transgender woman/trans woman
  • Male
  • Transgender man/trans man
  • Gender queer/gender nonconforming; neither exclusively male nor female
  • Additional gender category (or other); please specify:______________________
  • Decline to answer

Do you think of yourself as:

  • Straight or heterosexual
  • Lesbian or gay
  • Bisexual
  • Queer, pansexual, and/or questioning
  • Something else; please specify:_____________________
  • Don’t know
  • Decline to answer

Ask the patient why they are visiting your office today

This will be a consistent question on both your established and new patient intake forms.

Why have you come to see us today?

  • Annual wellness visit
  • Follow-up appointment for: _________________
  • Not feeling well. My symptoms are: _____________________________________
  • Required sports physical
  • Required pre-employment physical
  • Consultation referred by: ________________
    • A consultation form was provided: Y/N
    • If not, the consultation is focused on: _____________________

Understand the patient’s and their family’s medical history

You know why this information is essential. Rationally, your patient does, too. However, putting this request below why they are visiting your office helps them feel their focus on the now is as important to you as it is to them.

Share details about your medical history. Information that may seem irrelevant or unrelated may provide critical information to your ongoing care. Please be thorough:

  • Have you had surgery(ies) in the past? Y/N. If yes, when and where?________________
    • Were there any complications with previous surgeries? Y/N. If yes, what complications did you experience during which surgery (for example, excessive bleeding, reactions to anesthesia, malignant hyperthermia)? _________________
  • Do you experience chronic ailments? Circle any that apply: acid reflux, allergies, anxiety, arthritis, asthma, depression, diabetes, hearing loss, heart disease, high cholesterol, hypertension, joint pain, migraines, multiple sclerosis, obesity, scoliosis, shortness of breath, sleep apnea, other: _________________________________________
  • Have any medical devices been implanted internally? Y/N. If yes, what and when? _________________________________________
  • Are you required to take antibiotics (prophylaxis) before procedures? Y/N
  • Do you use a CPAP, dentures, hearing aids, or prosthetic(s)? Y/N _________________________
  • What medications do you take? Please include doses and frequency.  ___________________________________________
  • Are you allergic to any medications? If yes, what happens? ________________________________
  • Do you take any supplements or herbs? If yes, what and what dosage? _____________________________________

Tell us about your family’s medical history. Please share health disorders or significant illnesses they have experienced: ____________________________________________________________________________________________________________________________________________

Get to know your patient’s lifestyle habits

Tell us about how you like to spend your time:

What hobbies do you have? ________________________________________

What type of exercise do you like to do, and how often? ________________________

Have you ever had a problem with the overuse of alcohol? Y/N

Do you smoke or vape? Y/N. If yes, how often? _________________________

Do you currently use recreational or illegal drugs? Y/N. If yes, what and how often? ______________________________________

Have you previously used recreational or illegal drugs? Y/N. If yes, what and how often? _____________________________________ When did you use last? ________________

Capture your patient’s insurance information

This question has intentionally been placed near the bottom of the intake form. You want to subconsciously make the patient feel that getting to know about them is more critical than their wallet. However, as nice as that sentiment is, this information is essential to your business’ solvency, so it needs to be captured.

Have you provided a copy of your current insurance card? Y/N

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Necessary compliance and consent notices

Ensure you provide written confirmation that you comply with HIPAA and your office’s printed HIPAA notice. Within the context of this confirmation statement, you will also disclose that you may need to provide insurance provider(s) or additional consulting medical providers with the patient’s protected health information (PHI).

Ensure you provide written confirmation that you comply with HIPAA and your office’s printed HIPAA notice. ”

The patient will need to sign the form providing consent for the release of medically necessary information. The signature must be executed electronically or physically, depending on the medium used to complete the form.

What’s the best format for medical intake forms: electronic or paper?

The best answer to this question is actually, in some cases, both. Giving your patients an option for how they want to receive and manage the questionnaire that will hold their personal information sends a subtle message that your patients’ preferences matter to you.

So, how do you format an intake form? Patient satisfaction is essential, but your practice is also a business, so you should consider the cost of creating and managing these forms.

e-Forms

Electronic forms require programming and additional fees to your existing EHR process. Additionally, your patient intake forms are temporarily inaccessible if systems are down for any reason.

Paper forms

As a general rule, aging patients typically prefer paper over electronic options. Paper forms require a secure, physical filing space that complies with HIPAA and other regulatory requirements. They also incur additional costs due to the postage necessary to mail them to your patients — sometimes multiple times. 

Form accessibility

Considering the functionality of anything within this industry is not a new practice. In terms of patient intake forms, several considerations must be thought through.

Font size

Just as there are 2 sides to a coin, there are 2 ways to consider the font size you use for your patient intake forms — particularly the printed ones.

One way to think about font size is from the perspective of using less paper. Therefore, the smaller the font, the fewer pages you will need for your patient intake forms. While this may lead to an insignificant amount of cost savings, it is also likely to lead to angst and frustration for anyone with vision limitations.

Make sure your web developer incorporates the option allowing users to adjust the size of the view shown on the screen. ”

Ideally, documents should be published in a 14-point (19 pixels) font. A 12-point (16 pixels) font is currently considered the standard. This helps those with older eyes that have started degenerating.

Additionally, ensure your web developer incorporates the option allowing users to adjust the size of the view shown on the screen.

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Access to and ability to use electronic mediums

It may seem nearly incomprehensible that there would be those without access to electronic mediums; however, it is a reality. As of 2023, 8% of American households did not have access to the internet.

With that in mind, it is ideal to offer your patients the choice of:

  • Accessing their intake forms electronically via your patient portal
  • Providing a digital link to the necessary forms via email or text message to allow the patients the option to print and complete the forms at their leisure at home
  • Arriving 15 minutes earlier to complete the required intake paperwork

The other consideration is that there are those with access to the internet, but they’re neither comfortable nor proficient with the platform. Creating a mandatory option that results in frustration and feelings of inadequacy is not how you want to begin your relationship with new patients.

Language barriers

America is a proud, proverbial melting pot. That said, some are not fluent in English. Therefore, offering language alternatives or access to translators is beyond optional; it’s essential. At a minimum, all written information should be available in both English and Spanish.

Reasonable accommodations

The Americans with Disabilities Act (ADA) of 1990 brought the phrase, ‘reasonable accommodation,’ into the forefront of most business owners’ minds. It boils down to ensuring you do what you can to help someone with a disability be able to complete the basic tasks necessary to receive treatment in a way that doesn’t cause your practice ‘undue hardship.’

Provide a staff member to assist a vision-impaired or mobility-impaired individual in completing their patient intake paperwork. ”

In practice, as it relates to this article, it means that you provide a staff member to assist a vision-impaired or mobility-impaired individual in completing their patient intake paperwork.

Create a patient-centric intake form

Collecting your patient’s information can be challenging for all involved. However, setting the expectation that the next time the patient visits you will be a much easier and faster process will make them feel better.

Whether you design your medical intake form to have a combination of checkboxes, options to be circled, or blanks to be filled in, you will be able to gather the data you need to help your patient.

Tebra is always here to help. Check out our patient intake solution and take some of the stress off your shoulders.

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Karmin Gentili

Karmin Gentili has several years of freelance writing and editor experience. After over 25 years in corporate management roles, she has further elevated her skills by receiving multiple certifications, including copywriting and SEO specializations. Her love of writing motivates her to use those skills to develop content so others can work toward achieving their goals.

Reviewed by

Drew Sutton

Dr. Drew Sutton is a board-certified ENT physician. He has vast experience in treating all aspects of ENT, with particular interests in disorders of the ear and nasal and sinus disease. During his career, he started and managed an independent, single-specialty medical practice in a large metropolitan area.

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