Dental Practice Intake
Complete dental intake from medical history to payment
Dental practices need a specific mix of medical and dental history, insurance verification, and consent — often for patients they've never seen before. This workflow packages everything into a single, multi-page form: general medical history and medications, dental-specific questions (last visit, concerns, anxiety level), insurance card photo uploads, informed consent with e-signature, optional copay or deposit payment, and appointment booking. Patients complete the entire intake before their first visit.
How it works — 6 steps
Medical history and medications
Patients complete a comprehensive medical history including allergies, current medications, and conditions relevant to dental treatment (bleeding disorders, heart conditions, etc.).
Dental-specific questions
Custom fields capture dental history: last dental visit, current concerns, dental anxiety level, teeth sensitivity, and cosmetic goals.
Insurance card photos uploaded
Patients photograph the front and back of their dental insurance card. The images are attached to the submission and linked to the patient record.
Consent forms signed
Informed consent for treatment, HIPAA notice, and financial responsibility agreement are presented with e-signature fields.
Payment collected
An optional Stripe payment field collects a copay, deposit, or new patient fee as part of the intake form.
Appointment booked
Patients select an available time slot at the end of the form. Calendar invites are sent and the patient record is created with all intake data attached.
Features used in this workflow
Expected results
Ideal for
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