Building a Better Dental Patient Intake Form: Fields That Actually Matter

A dental intake form that just collects name, address, and insurance card is doing the bare minimum. The best dental practices use their intake form to surface critical information before the patient sits in the chair: allergies that affect anesthesia choice, medications that cause dry mouth, anxiety levels that change how you communicate during treatment.

Here's what a thorough dental patient intake form should include.

Demographics and Contact Information

Standard but essential: full name, date of birth, address, phone, email, emergency contact. Include preferred name and preferred contact method, small details that improve the patient experience from the first interaction.

Medical History Relevant to Dentistry

Dental care doesn't happen in a medical vacuum. You need to know about:

• Cardiovascular conditions: patients on blood thinners need modified treatment plans for extractions and surgeries
• Diabetes: affects healing time and infection risk
• Pregnancy: limits imaging and certain medications
• Joint replacements: some patients require antibiotic prophylaxis
• Bisphosphonate use: critical flag for any surgical procedures
• Bleeding disorders: affects everything from scaling to extractions

A simple yes/no conditions checklist gets you 80% of the way. Follow-up fields with conditional logic handle the rest.

Current Medications and Allergies

Medication history is non-negotiable. Beyond the obvious (latex allergy, antibiotic allergies), you need to capture medications that interact with local anesthetics, cause xerostomia, or increase bleeding risk.

Structure this as a searchable medication field rather than a blank text box. Patients remember medications better when they can search and select rather than spell from memory.

Dental History

This is where dental intake diverges from general medical intake:

• Last dental visit: date and location, helps establish continuity of care
• Chief complaint: the reason they're here today, in their own words
• Dental anxiety level: a simple 1-5 scale transforms how your team approaches the appointment
• Orthodontic history: previous braces, retainers, or aligners
• History of dental trauma: chipped, cracked, or avulsed teeth
• TMJ symptoms: jaw clicking, pain, difficulty opening
• Grinding or clenching: daytime and nighttime bruxism
• Oral hygiene habits: brushing frequency, flossing, mouthwash use

The dental anxiety question alone is worth digitizing your intake. When the hygienist knows a patient is anxious before walking in, they can adjust their approach, offer noise-canceling headphones, or simply take more time explaining each step.

Insurance and Billing

Dental insurance is its own universe. Capture:

• Primary and secondary insurance carriers
• Group and member ID numbers
• Subscriber information (if the patient isn't the subscriber)
• Employer name

Getting insurance details digitally before the appointment means your front desk can verify benefits before the patient arrives, eliminating the awkward mid-appointment "your insurance doesn't cover this" conversation.

Consent and Acknowledgments

At minimum: consent for treatment, consent for imaging (radiographs), acknowledgment of financial responsibility, and a HIPAA privacy notice. E-signatures make this seamless, letting patients sign on their phone rather than juggling clipboards in the waiting room.

Building This in Practice

You can build a complete dental intake form in Formisoft in about 15 minutes. The AI builder generates a solid starting point from a prompt like "dental patient intake form with medical history and dental anxiety screening." From there, use the drag-and-drop canvas to add specialty fields. The built-in medication, allergy, and conditions fields handle the clinical sections, and conditional logic keeps the form from overwhelming patients who have simple histories.

Send it to patients via magic-link email before their appointment. They fill it out on their phone, you get structured data instead of illegible handwriting, and chair time goes to dentistry instead of paperwork.

Try Formisoft free and build your dental intake form today.