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Healthcare Form Templates

Browse 32 ready-to-use healthcare form templates. Preview every field below, then customize for your practice in minutes.

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Intake Templates

16 templates
IntakePopular

New Patient Intake Form

Comprehensive intake form with demographics, insurance, medical history, and consent. The most popular template for primary care, specialty clinics, and multi-provider practices.

4 pages24 fieldsHIPAA-ready

Form fields preview

Full NameText
Date of BirthDate
Phone NumberPhone
Email AddressEmail
Home AddressAddress
Emergency ContactText
Insurance ProviderDropdown
Policy NumberText
Insurance Card (Front/Back)File Upload
Current MedicationsLong Text
Known AllergiesChecklist
Medical ConditionsChecklist
Reason for VisitLong Text
HIPAA ConsentE-Signature
IntakePopular

Mental Health Intake Form

Specialized intake for behavioral health and therapy practices. Includes mood assessment (PHQ-9/GAD-7 style), treatment history, substance use screening, safety assessment, and therapy goals.

3 pages18 fieldsHIPAA-ready

Form fields preview

Patient DemographicsText
Reason for Seeking TreatmentLong Text
Mood Assessment (PHQ-9)Scale
Anxiety Assessment (GAD-7)Scale
Previous Therapy/CounselingLong Text
Current Medications (Psychiatric)Long Text
Substance Use HistoryChecklist
Safety AssessmentChecklist
Treatment GoalsLong Text
Emergency ContactText
Consent for TreatmentE-Signature
IntakePopular

Pediatric Intake Form

Child-specific intake form with developmental milestones, immunization records, birth history, school information, and parent/guardian details. Designed for pediatric and family medicine practices.

3 pages20 fieldsHIPAA-ready

Form fields preview

Child's Name & Date of BirthText
Parent/Guardian InformationText
Birth History (Weight, Delivery Type)Text
Developmental MilestonesChecklist
Immunization RecordsChecklist
AllergiesChecklist
Current MedicationsLong Text
School & Grade LevelText
Behavioral ConcernsLong Text
Insurance InformationText
Consent Signature (Parent/Guardian)E-Signature
Intake

Dental Patient Intake Form

Dental-specific intake covering oral health history, dental anxiety assessment, previous dental work, TMJ symptoms, and dental insurance verification. For general dentistry, orthodontics, and oral surgery.

2 pages16 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Dental HistoryChecklist
Last Dental VisitDate
Previous Dental WorkChecklist
Dental Anxiety LevelScale
TMJ/Jaw Pain SymptomsChecklist
Oral Hygiene HabitsDropdown
Medical Conditions Affecting DentalChecklist
Dental InsuranceText
Consent to TreatmentE-Signature
Intake

Physical Therapy Intake Form

PT-specific intake with injury mechanism, pain assessment (VAS scale), functional limitations, range of motion goals, and treatment expectations. For physical therapy, sports medicine, and rehabilitation clinics.

2 pages15 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Referring PhysicianText
Injury/Condition DescriptionLong Text
Date of Injury/OnsetDate
Pain Location (Body Map)Dropdown
Pain Level (VAS 0-10)Scale
Functional LimitationsChecklist
Previous PT/TreatmentLong Text
Treatment GoalsLong Text
Insurance AuthorizationText
Intake

Chiropractic Intake Form

Chiropractic-specific intake covering spinal complaints, pain patterns, lifestyle factors, previous chiropractic care, and X-ray/imaging history. Built for chiropractic and wellness practices.

3 pages17 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Primary ComplaintLong Text
Pain Pattern & FrequencyDropdown
Pain LocationChecklist
Aggravating/Relieving FactorsChecklist
Previous Chiropractic CareLong Text
Imaging History (X-ray/MRI)Checklist
Lifestyle AssessmentChecklist
Occupation & ErgonomicsText
Medical HistoryChecklist
Consent to TreatmentE-Signature
Intake

Dermatology Intake Form

Dermatology-specific intake with skin concern history, sun exposure assessment, skin cancer screening questions, cosmetic treatment history, and photo upload for lesion documentation.

2 pages14 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Primary Skin ConcernLong Text
Duration of ConcernDropdown
Sun Exposure HistoryChecklist
Skin Cancer Risk FactorsChecklist
Previous Skin TreatmentsChecklist
Current Skincare RoutineLong Text
Photo Upload (Affected Area)File Upload
Medical HistoryChecklist
Consent to TreatmentE-Signature
Intake

Ophthalmology Intake Form

Eye care intake form with vision history, current symptoms, eye surgery history, contact lens/glasses prescription, and family eye disease history. For ophthalmology and optometry practices.

2 pages15 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Current Vision SymptomsChecklist
Glasses/Contact Lens PrescriptionText
Previous Eye SurgeriesChecklist
Family Eye Disease HistoryChecklist
Screen Time & Occupational UseDropdown
Eye Medications (Drops/Ointments)Long Text
Dry Eye SymptomsScale
General Medical HistoryChecklist
Consent to ExaminationE-Signature
Intake

OB/GYN Intake Form

Obstetrics and gynecology intake with menstrual history, pregnancy history, contraceptive use, gynecological symptoms, and reproductive health screening. For OB/GYN and women's health practices.

4 pages22 fieldsHIPAA-ready

Form fields preview

Patient DemographicsText
Menstrual HistoryText
Pregnancy History (G/P)Long Text
Contraceptive UseDropdown
Gynecological SymptomsChecklist
Pap Smear & Mammogram DatesDate
STI Screening HistoryChecklist
Surgical/Gynecological HistoryChecklist
Family Reproductive HistoryChecklist
Current MedicationsLong Text
Consent for ExaminationE-Signature
Intake

Orthopedics Intake Form

Orthopedic intake covering musculoskeletal complaints, injury mechanism, imaging history, joint function assessment, and surgical history. For orthopedic surgeons and sports medicine practices.

3 pages18 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Primary ComplaintLong Text
Injury MechanismDropdown
Date of Injury/OnsetDate
Pain Level (0-10)Scale
Joint Function AssessmentChecklist
Imaging History (X-ray/MRI/CT)Checklist
Previous Orthopedic SurgeriesLong Text
Activity LimitationsChecklist
Workers Comp / Auto AccidentMultiple Choice
Insurance & AuthorizationText
Consent to TreatmentE-Signature
Intake

Urgent Care Intake Form

Streamlined intake for urgent care and walk-in clinics. Captures chief complaint, symptom timeline, vitals triage, allergies, and current medications in a fast-paced single-page format.

1 page10 fieldsHIPAA-ready

Form fields preview

Patient Name & Date of BirthText
Chief ComplaintDropdown
Symptom DescriptionLong Text
Symptom OnsetDropdown
AllergiesChecklist
Current MedicationsLong Text
Relevant Medical HistoryChecklist
Insurance InformationText
Photo ID UploadFile Upload
Consent to TreatmentE-Signature
Intake

Sports Medicine Intake Form

Sports medicine intake with athletic history, sport-specific injury assessment, training regimen, concussion history, and return-to-play goals. For sports medicine and athletic training facilities.

3 pages16 fieldsHIPAA-ready

Form fields preview

Athlete InformationText
Sport & PositionText
Competition LevelDropdown
Current Injury/ComplaintLong Text
Mechanism of InjuryDropdown
Previous Sports InjuriesLong Text
Concussion HistoryChecklist
Training RegimenLong Text
Pain Level (0-10)Scale
Return-to-Play GoalsLong Text
Consent to TreatmentE-Signature
Intake

Allergy & Immunology Intake Form

Allergy and immunology intake with detailed allergy history, environmental triggers, reaction severity, immunodeficiency screening, and medication/immunotherapy history. For allergists and immunologists.

3 pages16 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Allergy History (Food/Drug/Environmental)Checklist
Reaction Descriptions & SeverityLong Text
Environmental TriggersChecklist
Seasonal Symptom PatternsDropdown
Previous Allergy TestingChecklist
Immunodeficiency ScreeningChecklist
Current Allergy MedicationsLong Text
Immunotherapy HistoryLong Text
Epinephrine Auto-Injector (Y/N)Yes/No
Consent to Testing/TreatmentE-Signature
Intake

Annual Wellness Visit Form

Pre-visit form for annual physicals and wellness exams. Covers health changes since last visit, preventive screenings due, vaccination history, and current health goals.

2 pages10 fieldsHIPAA-ready

Form fields preview

Changes Since Last VisitLong Text
New MedicationsLong Text
Preventive Screenings DueChecklist
Vaccination HistoryChecklist
Current Health ConcernsLong Text
Health GoalsLong Text
Intake

Follow-Up Visit Form

Short pre-visit form for return patients. Captures treatment progress, symptom changes, medication updates, and new concerns since the last appointment.

1 page5 fieldsHIPAA-ready

Form fields preview

Changes Since Last VisitLong Text
Current SymptomsChecklist
Medication ChangesLong Text
New Concerns or QuestionsLong Text
Pain Level (0-10)Scale

Medical History Templates

4 templates
Medical History

Medical History Questionnaire

Detailed medical history form covering past conditions, current medications, allergies, surgical history, and family medical history. Essential for new patients and annual updates.

3 pages14 fieldsHIPAA-ready

Form fields preview

Past Medical ConditionsChecklist
Surgical HistoryLong Text
Current MedicationsLong Text
Medication AllergiesChecklist
Food & Environmental AllergiesLong Text
Family HistoryChecklist
Social History (Smoking/Alcohol)Dropdown
Current SymptomsChecklist
Pain Level (0-10)Scale
Primary Care PhysicianText
Medical History

Surgical History Form

Detailed surgical history documentation covering past procedures, anesthesia reactions, complications, implanted devices, and blood transfusion history. Critical for pre-operative planning.

2 pages12 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Previous Surgeries (List)Long Text
Anesthesia History & ReactionsChecklist
Surgical ComplicationsChecklist
Implanted Devices/HardwareLong Text
Blood Transfusion HistoryYes/No
Current Blood ThinnersLong Text
Recovery PatternDropdown
Consent for Records ReleaseE-Signature
Medical History

Family Medical History Form

Structured family history form covering hereditary conditions across first and second-degree relatives. Organized by condition category for genetic risk screening and preventive care planning.

2 pages10 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Cancer History (by Type)Checklist
Cardiovascular Disease HistoryChecklist
Diabetes HistoryChecklist
Neurological ConditionsChecklist
Autoimmune DisordersChecklist
Mental Health HistoryChecklist
Relative Details (Who/Age of Onset)Long Text
Adopted/Unknown Family HistoryYes/No
Medical History

Medication Reconciliation Form

Structured medication list form with dosage, frequency, prescribing physician, pharmacy information, and adherence assessment. Essential for transitions of care and preventing medication errors.

1 page8 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Prescription MedicationsLong Text
Over-the-Counter MedicationsLong Text
Vitamins & SupplementsLong Text
Medication AllergiesChecklist
Adherence AssessmentChecklist
Pharmacy InformationText
Provider Verification SignatureE-Signature

Screening Templates

5 templates
Screening

PHQ-9 Depression Screening

Standardized PHQ-9 depression screening questionnaire with scoring, severity interpretation, and clinical action recommendations. Validated screening tool used in primary care and behavioral health.

1 page12 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Little interest or pleasure in doing thingsMultiple Choice
Feeling down, depressed, or hopelessMultiple Choice
Trouble falling or staying asleepMultiple Choice
Feeling tired or having little energyMultiple Choice
Poor appetite or overeatingMultiple Choice
Feeling bad about yourselfMultiple Choice
Trouble concentratingMultiple Choice
Moving or speaking slowly/being fidgetyMultiple Choice
Thoughts of self-harmMultiple Choice
Difficulty these problems have causedDropdown
Screening

GAD-7 Anxiety Screening

Standardized GAD-7 anxiety screening questionnaire with auto-scoring, severity levels, and clinical guidance. Validated tool for generalized anxiety disorder screening in clinical settings.

1 page10 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Feeling nervous, anxious, or on edgeMultiple Choice
Not being able to stop worryingMultiple Choice
Worrying too much about different thingsMultiple Choice
Trouble relaxingMultiple Choice
Being so restless that it's hard to sit stillMultiple Choice
Becoming easily annoyed or irritableMultiple Choice
Feeling afraid something awful might happenMultiple Choice
Difficulty these problems have causedDropdown
Screening

Substance Use Screening (CAGE-AID)

Substance use screening based on CAGE-AID adapted for drugs and alcohol. Includes frequency assessment, impact evaluation, and readiness for change. For primary care and behavioral health screening.

2 pages12 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Have you felt you should cut down?Multiple Choice
Have people annoyed you about your use?Multiple Choice
Have you felt guilty about your use?Multiple Choice
Have you used first thing in the morning?Multiple Choice
Alcohol Use FrequencyDropdown
Drug Use FrequencyDropdown
Tobacco/Nicotine UseDropdown
Impact on Daily LifeChecklist
Readiness for ChangeScale
Confidentiality AcknowledgmentCheckbox
Screening

Fall Risk Screening Form

Fall risk assessment for older adults covering fall history, medication review, mobility assessment, environmental hazards, and fear of falling. Based on CDC STEADI protocol for fall prevention.

2 pages10 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Fall History (Past 12 Months)Dropdown
Fall Circumstances & InjuriesLong Text
Current Medications (Count)Number
High-Risk MedicationsChecklist
Balance & Mobility ConfidenceScale
Vision ConcernsChecklist
Home Environmental HazardsChecklist
Fear of FallingScale
Assessment DateDate
Screening

Social Determinants of Health Screening

SDOH screening covering food security, housing stability, transportation access, financial strain, personal safety, and social isolation. Based on CMS-recommended screening tools for value-based care.

2 pages12 fieldsHIPAA-ready

Form fields preview

Patient InformationText
Food SecurityMultiple Choice
Housing StabilityMultiple Choice
Utility DifficultiesMultiple Choice
Transportation AccessMultiple Choice
Financial StrainMultiple Choice
Personal SafetyMultiple Choice
Social IsolationMultiple Choice
Education & Health LiteracyDropdown
Would you like help with any of these?Checklist
Screening DateDate

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Why use healthcare form templates?

Healthcare form templates save your practice hours of setup time. Instead of building intake forms from scratch, start with a template that already includes the right fields for your specialty — from patient demographics and insurance capture to medical history checklists and e-signature consent.

Every Formisoft template is designed specifically for healthcare. That means HIPAA-ready field types, proper data handling for protected health information (PHI), and built-in compliance features like audit logging and encryption. Unlike generic form builders, our templates understand healthcare workflows out of the box.

All templates are fully customizable. Add or remove fields, rearrange pages, set up conditional logic (like showing medication details only when a patient indicates they take medications), and apply your practice’s branding — your logo, colors, and fonts.