Templates | Formisoft Client Intake Forms

Jump-start your forms with our professionally designed templates.

Full Name

Date of Birth

Position/Job Title

+13 more fields

Workplace Ergonomics Assessment Intake Form

Medical Intake

Collect information to assess ergonomic needs and workplace adjustments for employees.

Work Environment Allergy Checklist

Medical Intake

Identify any allergies or sensitivities that employees may have related to the work environment.

Full Name

Phone Number

+6 more fields

Warranty Claim Form

Customer Support Intake

Submit a claim for a warranty issue with a product.

Travel and Relocation Health Assessment Form

Medical Intake

Assess the health of employees before travel or relocation for work purposes.

I understand the benefits and risks of telemedicine, and I agree to participate in telemedicine services.

Full Name

+3 more fields

Telemedicine Consent Form

Medical Intake

Capture patient consent for telemedicine services.

Full Name

Phone Number

+5 more fields

Technical Support Request Form

Customer Support Intake

Submit a request for technical support for issues related to technology or software.

Full Name

Phone Number

+4 more fields

General Support Request Form

Customer Support Intake

Submit a general support request or report an issue.

Full Name

Phone Number

+3 more fields

Feedback and Suggestions Form

Customer Support Intake

Provide feedback or suggestions for improving our products or services.

Full Name

Phone Number

+5 more fields

Service Request Form

Customer Support Intake

Request service or maintenance for a product or system.

Full Name

Phone Number

+3 more fields

Waiting List Form

Sales Intake

Sales Representative's Name

How would you rate the sales representative's knowledge of the product/service?

How would you rate the representative's responsiveness?

+3 more fields

Sales Team Performance Review Form

Sales Intake

Collect data to evaluate sales team performance.

Full Name

Company Name

+4 more fields

Renewal Sales Intake Form

Sales Intake

Collect information from clients who are renewing contracts or subscriptions.

Full Name

Company Name

+5 more fields

Product Demo Request Form

Sales Intake

Collect information for scheduling a product demonstration.

Sales Order Intake Form

Sales Intake

Gather detailed information to complete a sales order.

Full Name

Company Name

+5 more fields

Client Onboarding Form

Sales Intake

Collect important client details for onboarding after a successful sale.

Full Name

Company Name

+5 more fields

Lead Qualification Intake Form

Sales Intake

Gather information to qualify potential sales leads.

Rehabilitation Progress Form

Medical Intake

Track and document the progress of a patient undergoing rehabilitation.

Your Name

Your Email

Name of the Person You're Referring

+3 more fields

Referral Intake Form

Sales Intake

Collect information from customers who are referring others to your products or services.

Full Name

Phone Number

+3 more fields

Product/Service Inquiry Form

Customer Support Intake

Submit an inquiry about a product or service.

Full Name

Phone Number

+5 more fields

Product Return Form

Customer Support Intake

Submit a request to return a product.

Full Name

Date of Birth

Do you have any allergies to medications?

+4 more fields

Pre-Surgery Assessment Form

Medical Intake

Assess readiness for surgery and collect necessary information.

Pre-Employment Risk Factor Assessment Form

Medical Intake

Assess potential health risk factors for new employees before employment.

Pre-Employment Health Questionnaire

Medical Intake

Collect relevant health information from potential employees before employment.

Child's Full Name

Date of Birth

Parent/Guardian Full Name

+7 more fields

Pediatric Patient Information Form

Medical Intake

Perfect for pediatricians to collect patient information.

Patient Satisfaction Survey

Medical Intake

Capture patient feedback with a professional survey.

Patient Demographics Form

Medical Intake

Capture patient demographic information such as name, date of birth, gender, ethnicity, race, marital status, primary language, and signature.

Partner Company Name

Contact Person

+4 more fields

Partnership Sales Intake Form

Sales Intake

Collect information from potential business partners for sales opportunities.

Immunization Record for Occupational Health

Medical Intake

Collect immunization records from employees for occupational health purposes.

New Patient Registration

Medical Intake

Allow patients to easily register as new patients.

Mental Health and Stress Level Assessment Form

Medical Intake

Evaluate the mental health and stress levels of employees for workplace support and well-being.

Medication Refill Request

Medical Intake

Allow patients to request medication refills easily.

Full Name

Date of Birth

Primary Care Physician

+11 more fields

Medical History Form

Medical Intake

Patient medical and health history form.

Principal's Full Name

Agent's Full Name

Type of Power of Attorney

+3 more fields

Power of Attorney Intake Form

Legal Intake

Collect necessary details to prepare a Power of Attorney document.

Date of Incident

Location of Incident

Description of the Incident

+5 more fields

Personal Injury Intake Form

Legal Intake

Gather information about personal injury incidents for legal consultation.

Full Name

Country of Origin

Current Immigration Status

+4 more fields

Immigration Law Intake Form

Legal Intake

Collect details for an immigration law case consultation.

Estate Planning Intake Form

Legal Intake

Collect personal and asset information for estate planning.

Client Information Form

Legal Intake

Basic intake form to collect client information for legal consultation.

Legal Case Details Form

Legal Intake

Collect detailed information about the client's legal case.

Insurance Provider

Insurance Policy Number

Group Number

+5 more fields

Insurance Information Form

Medical Intake

Allow patients to easily provide their insurance information.

I have read and understand the Notice of Privacy Practices.

I consent to the use and disclosure of my health information for treatment, payment, and healthcare operations.

+4 more fields

HIPAA Privacy Acknowledgment

Medical Intake

Capture patient acknowledgment of HIPAA privacy practices.

Diabetes Monitoring Form

Medical Intake

Track important health data for effective diabetes management.

Follow-Up Visit Information

Medical Intake

Securely collect follow-up visit information with this professional form.

Employee Full Name

Date of Birth

Date of Original Exposure

+11 more fields

Follow-Up Visit for Occupational Exposure Form

Medical Intake

Document follow-up visits for employees who have experienced occupational exposure.

Comprehensive Health History and Current Health Status Form

Medical Intake

Capture a detailed health history and current health status for new employees.

Full Name

Date of Birth

+8 more fields

Doctor’s Appointment Request Form

Medical Intake

Submit a request for scheduling a doctor’s appointment.

Full Name

Product/Service Purchased

+4 more fields

Customer Feedback Intake Form

Sales Intake

Collect feedback from customers to improve sales processes and products.

Client Name

Company Name

Current Products/Services Used

+4 more fields

Cross-Selling Opportunity Form

Sales Intake

Identify potential cross-selling opportunities from existing clients.

Have you experienced any of the following symptoms in the past 14 days?

Have you been in contact with anyone diagnosed with COVID-19 in the past 14 days?

Have you traveled internationally in the last 14 days?

+4 more fields

COVID-19 Screening Form

Medical Intake

COVID-19 screening form for healthcare providers.

Full Name of Employee

Date of Birth

Position/Job Title

+8 more fields

Consent for Medical Examination Form for Employee

Medical Intake

Collect consent from employees before a medical examination for occupational purposes.

I have read and understand the treatment description.

Full Name

+3 more fields

Consent for Treatment

Medical Intake

Capture patient consent for treatment with a professional form.

Full Name

Phone Number

+4 more fields

Billing Support Request Form

Customer Support Intake

Submit a request for assistance with billing or account issues.

Full Name

Date of Birth

Have you ever been diagnosed with a mental health condition?

+5 more fields

Behavioral Health Intake Form

Medical Intake

Capture patient information for behavioral health assessment.

Location of Pain

Pain Intensity (0-10)

Pain Duration

+4 more fields

Pain Assessment Form

Medical Intake

Assess pain levels and symptoms for patients.

Full Name

Phone Number

+4 more fields

Appointment Scheduling Form

Customer Support Intake

Schedule an appointment for support or service.

Full Name

Phone Number

+5 more fields

Account Access Request Form

Customer Support Intake

Request access to an account or service.