Need a professional and organized way to collect patient information? Our Medical Intake Form Template provides a ready-to-use, editable document for healthcare professionals to gather essential details from new or returning patients.
This form helps streamline the patient intake process, saving time and ensuring accuracy in medical records.
This template includes:
✔️ Patient contact and emergency information;
✔️ Medical history and current medications;
✔️ Lifestyle information (smoking, alcohol, exercise);
✔️ Reason for visit section;
✔️ Authorization and signature fields;
✔️ Fully editable format in Microsoft Word.
Who should use this template?
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Private medical clinics;
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Psychologists and mental health providers;
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Physical therapists and rehabilitation centers;
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Nutritionists, chiropractors, and wellness clinics.
Having a structured intake form helps deliver better care and maintain accurate records.
Pro Tip: Keep printed copies available at your front desk and use the editable version for digital records.
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