The Complete Patient Intake Checklist: Everything to Collect Before the Visit

A solid patient intake process collects everything a provider needs before the appointment starts. Miss a section and staff are chasing information during the visit. Over-collect and patients abandon the form halfway through.

Here's the complete checklist, organized by section, with practical tips for each.

1. Patient Demographics

What to collect:

• Full legal name
• Preferred name (if different)
• Date of birth
• Sex assigned at birth
• Gender identity and pronouns
• Home address
• Phone number (mobile preferred)
• Email address
• Preferred language
• Emergency contact (name, phone, relationship)

Tip: Ask for mobile phone number first — it's the number patients actually answer, and it's where appointment reminders and intake links get delivered.

2. Insurance Information

What to collect:

• Primary insurance provider
• Policy/member ID number
• Group number
• Subscriber name and date of birth (if not the patient)
• Relationship to subscriber
• Photo of insurance card (front and back)
• Secondary insurance (if applicable)

Tip: The card photo is the single most valuable field here. It catches transcription errors and gives billing staff a fallback for every field the patient might leave blank.

3. Medical History

What to collect:

• Current and past medical conditions
• Previous surgeries (with approximate dates)
• Hospitalizations
• Family medical history (parents, siblings — major conditions)
• Immunization status (for primary care and pediatrics)

Tip: Use a checklist of common conditions rather than an open text field. Patients recall more when they see options like "diabetes," "hypertension," and "asthma" listed out. Add an "other" field for anything not listed.

4. Current Medications

What to collect:

• Medication name
• Dosage
• Frequency
• Prescribing provider (optional but useful)
• Over-the-counter medications and supplements

Tip: Let patients add multiple entries with a repeatable field group. One text box that says "list all medications" produces messy, incomplete data. Structured fields produce structured data.

5. Allergies

What to collect:

• Drug allergies (with reaction type)
• Food allergies
• Environmental/seasonal allergies
• Latex allergy (critical for clinical settings)

Tip: Always capture the reaction, not just the allergen. "Penicillin - rash" is medically different from "Penicillin - anaphylaxis" and changes clinical decision-making.

6. Current Visit Information

What to collect:

• Reason for visit / chief complaint
• Symptom onset and duration
• Pain level (if applicable)
• Referring provider (if applicable)

Tip: This section benefits the most from conditional logic. A patient selecting "annual physical" doesn't need pain scale questions. A patient selecting "injury" does. Tailor follow-up questions to the visit reason.

7. Social History

What to collect:

• Tobacco use (current, former, never)
• Alcohol use (frequency)
• Recreational drug use
• Occupation
• Exercise habits
• Diet (for relevant specialties)

Tip: Frame questions neutrally. "Do you currently use tobacco products?" performs better than loaded phrasing. Patients are more honest when the form feels clinical, not judgmental.

8. Consent and Legal

What to collect:

• Informed consent for treatment
• Privacy practices acknowledgment (HIPAA Notice of Privacy Practices)
• Financial responsibility agreement
• Authorization for release of information
• E-signature for each consent document

Tip: Keep consent forms on their own page, separate from clinical intake. This ensures patients actually read the consent language rather than scrolling past it buried between "allergies" and "pharmacy preference."

9. Payment Information

What to collect:

• Copay or self-pay amount
• Credit/debit card for payment or card on file
• Financial assistance screening (if applicable)

Tip: Collecting copays before the visit reduces billing overhead significantly. Embed a payment field directly in the intake form so patients handle everything in one session.

Putting It Together

This is a lot of information, but it doesn't have to feel that way to the patient. The key is multi-page forms with clear progress indicators, conditional logic that hides irrelevant sections, and pre-visit delivery so patients can complete intake at their own pace.

Formisoft supports all of these field types — insurance cards, medication lists, allergy tracking, e-signatures, Stripe payments, and conditional logic — in a drag-and-drop builder. Build your complete intake checklist once and send it to every new patient automatically. Try it at formisoft.com.