Patient intake form template
Patient intake forms can be extensive, time-consuming, and even overwhelming for patients to complete, especially when filling them out in the clinic. However, accurate and complete information is critical to providing quality care.
That’s why an online patient intake form can be so effective. You can craft the form to capture all of the details you need from your patients, and allow them to submit their information from the comfort of their own homes.
Use our patient intake form template to efficiently collect patient medical histories, vaccination records, allergies, emergency contact information, and more. Plus, the intuitive SurveyMonkey form builder allows you to adapt the form to your practice's needs while incorporating branding elements for a professional touch.
Explore which features support this survey template
We have so many powerful features to help you launch surveys quickly, but here are our most popular ones for new users.
Customizable survey experiences
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Many ways to send your surveys
Collect survey responses via email, website, SMS, social media, QR codes, offline, and more.
Survey analysis, no training required
Automatic results summaries, filters, custom dashboards, crosstab reports, text analysis, & more.
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Patient registration form template
Seamlessly collect patient registrations with our fully customizable, HIPAA-compliant patient registration form template.