Dermatology intake is visual. A patient can describe a rash in a text field, but a photo says more. The best derm intake combines structured history with photos, so the provider sees the concern before the appointment.
Demographics and Contact Information
Full name, date of birth, address, phone, email, emergency contact, and preferred pharmacy (dermatology often ends in a prescription).
Reason for Visit
Common categories:
- Skin concern (rash, lesion, mole, acne, eczema, psoriasis)
- Skin check / annual screening
- Cosmetic consultation
- Follow-up on existing condition
- Surgical follow-up
Let patients select a category, then provide an open text field for details. Follow up with: how long has the concern been present, is it getting better or worse, and has it been treated before?
Photo Upload for Skin Concerns
Let patients upload several photos of the concern before the visit. Ask for a close-up, a wider shot for context, and one with a size reference such as a coin. For virtual visits, these photos may be the main visual information the provider has.
Skin History
Questions specific to dermatology:
- Skin type: Fitzpatrick scale (I-VI) or simplified description (burns easily, tans easily, etc.)
- Sun exposure history: outdoor occupation, tanning bed use, sunburn frequency
- Skin cancer history: personal and family (melanoma, basal cell, squamous cell)
- Previous biopsies: location, date, results
- History of atypical moles
- Chronic skin conditions: eczema, psoriasis, rosacea, vitiligo, with onset and treatment history
Current Skincare Routine and Products
What patients put on their skin daily matters clinically:
- Cleanser, moisturizer, sunscreen (brand and frequency)
- Prescription topicals currently in use
- Over-the-counter treatments being used for the current concern
- Cosmetic products and makeup
- Recent changes to products or routine
This reveals contact dermatitis triggers, product interactions, and adherence.
Medication History
Dermatology-critical medications to flag:
- Isotretinoin (Accutane): current or past use, including dates
- Immunosuppressants: increases skin cancer risk
- Blood thinners: relevant for biopsies and procedures
- Photosensitizing medications: tetracyclines, certain diuretics, NSAIDs
- Biologics: for psoriasis, eczema, or other conditions
- Oral contraceptives: relevant for hormonal acne management
Beyond specific flags, capture all current medications and allergies. Drug allergies are particularly important when prescribing topical or oral antibiotics.
Medical History
Relevant conditions: autoimmune disorders, diabetes (affects wound healing), HIV/immunocompromised status, thyroid conditions (associated with hair and skin changes), and pregnancy status (limits treatment options significantly).
Family history of skin cancer, melanoma, psoriasis, and eczema.
Insurance and Billing
Standard insurance fields, plus one key question: is the visit medical or cosmetic? Acne is medical, Botox is cosmetic, some visits are both, and it decides how you bill.
Consent
Consent for examination, consent for photography (clinical photos for the medical record), consent for procedures if applicable, and HIPAA privacy notice. E-signatures keep this clean.
Building a Derm Intake Form
In Formisoft, patients upload photos straight from their phone camera, alongside built-in medication and allergy fields, conditional questions by visit type, and e-signed consent, all in one form. Attach it to your new patient visit type so it goes out when patients book. When photos, history, and consent are in before the appointment, the patient is ready.
See how Formisoft gets every patient ready before the visit.
Intake forms built for your specialty, ready before the visit.
- Forms, consents, and signatures before the visit
- Your paper forms converted by AI
- BAA included