formisoft

Healthcare Form Templates

Browse 218+ ready-to-use, HIPAA-ready form templates for every medical specialty. Fully customizable and ready in minutes.

Ready to useHIPAA-readyFully customizableReady in minutes

218+ Templates · 8 Categories · Every Specialty

Showing 1–30 of 218 templates

Full Name
Phone Number
Email Address
Reason for Seeking Treatment
Mood Assessment (PHQ-9)
Anxiety Assessment (GAD-7)
Previous Therapy/Counseling
Current Medications (Psychiatric)
+
Add
Submit
Intake
Popular

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 pages•13 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Phone Number
Email Address
Home Address
Emergency Contact
Insurance Information
Current Medications
+
Add
Submit
Intake
Popular

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 pages•12 fields•HIPAA-ready
Use template
Child's Name & Date of Birth
Phone Number
Email Address
Parent/Guardian Information
Birth History (Weight, Delivery Type)
Developmental Milestones
Immunization Records
Allergies
Submit
Intake
Popular

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 pages•13 fields•HIPAA-ready
Use template
Acupuncture Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Primary Reason for Treatment
Pain Location & Intensity
TCM Review of Systems
Sleep & Energy Assessment
Submit
Intake

Acupuncture Intake Form

Acupuncture-specific intake covering chief complaint, TCM constitution assessment, pain mapping, lifestyle and emotional health, and treatment history. For licensed acupuncturists and integrative medicine clinics.

3 pages•16 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Phone Number
Email Address
Primary Substance of Use
Select...
Substance Use History
Withdrawal Symptom Assessment
Prior Overdose History
Submit
Intake

Addiction Medicine Intake Form

Addiction medicine intake covering substance use history, withdrawal risk assessment, medication-assisted treatment screening, mental health comorbidities, recovery support systems, and treatment readiness. For addiction medicine practices and MAT programs.

3 pages•16 fields•HIPAA-ready
Use template
Allergy & Immunology Intake Form
Full Name
Phone Number
Email Address
Allergy History (Food/Drug/Environmental)
Reaction Descriptions & Severity
Environmental Triggers
Seasonal Symptom Patterns
Select...
Previous Allergy Testing
Submit
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 pages•13 fields•HIPAA-ready
Use template
Annual Wellness Visit Form
Patient Name
Date of Birth
Email Address
Phone Number
Current Medications
+
Add
Allergies
Medical Conditions
Family Medical History
Submit
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.

3 pages•15 fields•HIPAA-ready
Use template
Bariatric Surgery Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Current Weight & Height
Weight History Timeline
Obesity-Related Comorbidities
Diabetes & Metabolic Status
Submit
Intake

Bariatric Surgery Intake Form

Bariatric surgery-specific intake covering weight history, BMI documentation, obesity-related comorbidities, prior weight loss attempts, nutritional assessment, and psychological readiness screening. For bariatric surgery programs and metabolic centers.

3 pages•22 fields•HIPAA-ready
Use template
Behavioral Health Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Presenting Concerns
Behavioral Health Symptom Screen
Substance Use History
Trauma Exposure Screening
Submit
Intake

Behavioral Health Intake Form

Behavioral health intake covering presenting concerns, substance use screening, trauma history, psychosocial assessment, and treatment readiness. For behavioral health agencies, community mental health centers, and outpatient counseling practices.

4 pages•17 fields•HIPAA-ready
Use template
Cardiac Rehabilitation Intake Form
Patient Full Name
Date of Birth
Primary Cardiac Event
Select...
Date of Cardiac Event
Current Cardiac Symptoms
Referring Cardiologist
Current Cardiac Medications
+
Add
Exercise Limitations
Submit
Intake

Cardiac Rehabilitation Intake Form

Comprehensive intake form for cardiac rehabilitation programs collecting cardiovascular history, cardiac events, exercise capacity, risk factors, and recovery goals. Designed for post-MI, post-surgery, and heart failure patients beginning supervised cardiac recovery programs.

3 pages•18 fields•HIPAA-ready
Use template
Cardiology Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Chest Pain Assessment
Cardiac Symptom Checklist
Cardiovascular Risk Factors
Blood Pressure History
Submit
Intake

Cardiology Intake Form

Cardiology-specific intake covering cardiac symptoms, chest pain assessment, heart disease risk factors, and cardiovascular history. Designed for cardiologists, electrophysiologists, and heart failure clinics.

3 pages•16 fields•HIPAA-ready
Use template
Chiropractic Intake Form
Full Name
Phone Number
Email Address
Primary Complaint
Pain Pattern & Frequency
Select...
Pain Location
Aggravating/Relieving Factors
Previous Chiropractic Care
Submit
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 pages•14 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Phone Number
Email Address
Dental History
Last Dental Visit
Previous Dental Work
Dental Anxiety Level
Submit
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 pages•13 fields•HIPAA-ready
Use template
Full Name
Phone Number
Email Address
Primary Skin Concern
Duration of Concern
Select...
Sun Exposure History
Skin Cancer Risk Factors
Previous Skin Treatments
Submit
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 pages•12 fields•HIPAA-ready
Use template
Dialysis Center Patient Intake Form
Patient Full Name
Date of Birth
Primary Phone Number
Email Address
Emergency Contact
Insurance Information
Dialysis Type
Vascular Access Type
Select...
Submit
Intake

Dialysis Center Patient Intake Form

Comprehensive intake form for dialysis centers and renal care facilities treating patients with end-stage renal disease (ESRD). Captures vascular access information, dialysis history, fluid restrictions, and kidney-specific medical history to ensure safe and effective treatment planning.

3 pages•10 fields•HIPAA-ready
Use template
Endocrinology Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Primary Endocrine Concern
Diabetes History & Management
Glucose Monitoring Method
Select...
Thyroid Symptom Assessment
Submit
Intake

Endocrinology Intake Form

Endocrinology-specific intake covering diabetes management, thyroid disorders, hormonal symptoms, metabolic screening, and endocrine medication history. For endocrinologists and diabetes care centers.

4 pages•16 fields•HIPAA-ready
Use template
ENT (Ear, Nose & Throat) Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Primary ENT Concern
Ear Symptom Assessment
Hearing Loss History
Nasal & Sinus Symptoms
Submit
Intake

ENT (Ear, Nose & Throat) Intake Form

ENT-specific intake covering hearing loss, sinus symptoms, throat complaints, balance disorders, and allergy history. For otolaryngologists, audiologists, and head and neck surgery practices.

3 pages•16 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Phone Number
Email Address
Partner Information
Duration of Infertility
Pregnancy History
Menstrual Cycle Documentation
Submit
Intake

Fertility Clinic Intake Form

Fertility clinic-specific intake covering reproductive history, menstrual cycle documentation, prior fertility treatments, partner information, and psychosocial screening. For reproductive endocrinology, IVF centers, and fertility practices.

4 pages•22 fields•HIPAA-ready
Use template
Follow-Up Visit Form
Patient Name
Date of Birth
Phone Number
Email Address
Date of Last Visit
Reason for Follow-Up
Select...
Current Symptoms
Symptom Severity
Submit
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.

2 pages•13 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Phone Number
Email Address
Health Timeline & Symptom History
Current Conditions
Environmental Exposure Assessment
Diet & Nutrition Log
Submit
Intake

Functional Medicine Intake Form

A comprehensive functional medicine patient intake form for integrative and holistic health practices, capturing health timeline, environmental exposures, diet and nutrition, supplements, sleep and stress assessment, gut health, and toxin exposure history.

3 pages•16 fields•HIPAA-ready
Use template
Gastroenterology Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Primary GI Concern
Abdominal Pain Assessment
Digestive Symptom Checklist
Bowel Habit Changes
Submit
Intake

Gastroenterology Intake Form

GI-specific intake covering digestive symptoms, bowel habit assessment, prior endoscopic procedures, liver and pancreatic history, and dietary factors. For gastroenterologists and hepatology practices.

3 pages•16 fields•HIPAA-ready
Use template
Genetic Counseling Intake Form
Patient Full Name
Date of Birth
Phone Number
Email Address
Reason for Genetic Counseling
Family History of Genetic Conditions
Ethnic Background
Previous Genetic Testing
Submit
Intake

Genetic Counseling Intake Form

Comprehensive intake form for genetic counseling appointments capturing family history, hereditary conditions, and reasons for genetic consultation. Designed for genetics clinics, prenatal counseling centers, and oncology genetic services.

3 pages•10 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Phone Number
Email Address
Activities of Daily Living (ADLs)
Instrumental ADLs
Fall History & Risk Factors
Mobility & Gait Assessment
Select...
Submit
Intake

Geriatrics Intake Form

Geriatrics-specific intake covering functional assessment, fall risk screening, cognitive evaluation, polypharmacy review, advance directives, and caregiver information. For geriatricians and senior care practices.

4 pages•17 fields•HIPAA-ready
Use template
Home Health Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Homebound Status Justification
Hospital Discharge Information
Primary Diagnosis & Orders
Functional ADL Assessment
Submit
Intake

Home Health Intake Form

Home health intake covering homebound status, functional assessment, fall risk, medication management, caregiver support, and home safety evaluation. For home health agencies, visiting nurse services, and home-based primary care programs.

5 pages•17 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Email Address
Phone Number
Symptom Severity Assessment
Hormone Treatment History
Medical Conditions Screening
Current Medications & Supplements
+
Add
Submit
Intake

Hormone Replacement Therapy Intake Form

A hormone replacement therapy intake form for HRT clinics and endocrine practices, capturing symptom assessment, hormone treatment history, current medications, lab results, treatment goals, and informed consent.

3 pages•14 fields•HIPAA-ready
Use template
Full Name
Date of Birth
Phone Number
Email Address
Primary Diagnosis & Prognosis
Functional Status Assessment
Select...
Symptom Burden Assessment
Pain Assessment
Submit
Intake

Hospice & Palliative Care Intake Form

Hospice and palliative care intake covering terminal diagnosis, symptom burden assessment, advance directives, caregiver information, spiritual and psychosocial needs, and goals of care. For hospice agencies, palliative care programs, and end-of-life care teams.

3 pages•16 fields•HIPAA-ready
Use template
Infectious Disease Intake Form
Full Name
Date of Birth
Phone Number
Email Address
Referring Physician
Presenting Infection & Symptoms
Symptom Timeline
Travel History
Submit
Intake

Infectious Disease Intake Form

Infectious disease-specific intake covering infection history, travel and exposure assessment, immunization records, antimicrobial therapy history, and immune status evaluation. For ID consultations, HIV clinics, and tropical medicine practices.

3 pages•20 fields•HIPAA-ready
Use template
Infertility / IVF Intake Form
Full Name
Phone Number
Email Address
Partner Information
Menstrual History
Obstetric History
Previous Fertility Treatments
Reproductive Surgery History
Submit
Intake

Infertility / IVF Intake Form

A detailed fertility treatment intake form covering reproductive history, menstrual and obstetric history, previous treatments, partner information, and treatment goals for IVF and assisted reproduction.

4 pages•17 fields•HIPAA-ready
Use template
Insurance Verification Form
Patient Full Name
Date of Birth
Email Address
Phone Number
Insurance Information
Subscriber Name
Relationship to Subscriber
Select...
Insurance Card Front
Upload file
Submit
Intake

Insurance Verification Form

Collect insurance card photos (front and back), policy details, group number, and subscriber information. Enables pre-visit insurance verification to reduce claim denials.

2 pages•13 fields•HIPAA-ready
Use template
Interventional Radiology Patient Intake Form
Patient Full Name
Date of Birth
Phone Number
Email Address
Referring Physician
Scheduled Procedure
Select...
Contrast Allergy History
Current Anticoagulation
Submit
Intake

Interventional Radiology Patient Intake Form

Comprehensive intake form for interventional radiology practices performing minimally invasive image-guided procedures. Captures procedure history, contrast allergies, bleeding risks, and anticoagulation medications critical for safe IR interventions.

3 pages•10 fields•HIPAA-ready
Use template

Need a custom template?

Describe your intake form in plain English and our AI builds it in seconds, complete with the right fields, validation, and conditional logic for your specialty.

Try the AI form builderRequest a template

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 : patient demographics, insurance capture, 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. Or skip templates entirely and build with AI.