5 Things Missing From Your Intake Form (That You Should Add ASAP)

Not all intake forms are created equal.

While they primarily exist to give you as much information about a new patient as possible, sometimes you need more than just a name, address and insurance information to really assess the level of care and attention a patient will need at your clinic.

Your form is also one of the first interactions your patients have with your practice. A form that’s difficult to fill out or is missing important information (that patients may forget to relay later on) or otherwise inconvenient to submit may make a dismal first impression.

Thankfully there are a few things that you can add to your forms to make them more functional, both in terms of providing you with important information as well as offering more details for the patient, so they can understand how your office operates.

Here are a few things your forms should include:



It may seem a bit silly to include the branding of your clinic or hospital on an intake form, digital or otherwise. After all, most patients know that they’re submitting the form to your clinic. It’s not like you have to remind them, right?

According to Stewart Gandolf of Healthcare Success, branding is actually an important touch point for patients, whether they know it or not. “It turns out that branding your practice has some very tangible rewards,” he says. “People will happily pay more for a brand than for a generic alternative.”

Branding in general is important for building patient trust and brand recall, which may not seem like a big deal to your clinic now, but it may matter when it comes time for a patient to recommend your clinic to friends and family, or to return for more care.

If your form is on your website, the landing page should reflect the general style and branding choices of your website. That means using the same fonts, color schemes and even a logo if necessary.

If patients are expected to fill out PDF forms or print a copy of their online form, the PDF or downloadable form should also contain branding and styling.

Open-ended Questions

Patients may also have concerns about their care or want to include relevant health information that may not have a space on your current form. You won’t be able to predict every healthcare concern they may have, which is why you should also have a space on your form for open-ended questions.

This can be as simple as asking, “Is there anything else you want us to know?” or even having separate spaces for more specific questions, like, “Can you provide more information about the medications you’re taking?” or “Do you have any concerns about your visit before you arrive?”

Even if your doctors conduct a more thorough patient interview later on, it can be helpful to have a record of patient concerns that office staff can reference if necessary, or that doctors can read up on before the interview (in case they miss or forget to ask during the interview).

Most patients will probably leave these questions blank, but the ones who fill it out can provide valuable information about their health that may improve the overall care they’re given.

Psychological Health

More robust intake forms often include some psychological information, including history of depression or anxiety, but not all forms cover mental health issues.

Studies continue to show that mental health issues can cause or worsen physical symptoms, and in some cases it can be difficult to assess whether or not a patient’s pain is coming from a physical or psychological source (or both).

Knowing that a patient has a history of depression is a start, but providing room for them to explain any other mental health concerns (eating disorders, fibromyalgia, claustrophobia, general anxiety, history of abuse, etc.) may help doctors make better healthcare assessments during the intake process.

Not all patients will want to disclose this information, but having it available (perhaps as an open-ended question) for those that do can go a long way to showing that you have a more holistic approach to patient care.

Female doctor explaining diagnosis to her female patient

Preferred Name and Pronouns

Recent legislation and societal changes, including the legalization of gay marriage and the prominence of LGBTQ representation has changed the way that many healthcare clinics are approaching care for these groups.

While some clinics have begun making forms friendlier to the LGBTQ communities, like adding multiple options for gender identification, it may not always be possible for your online or paper forms to do so.

If this is the case, you can still include customizable fields or open-ended questions that address some of these concerns, including spaces for preferred name or pronouns.

According to Nurse.org, many LGBTQ patients suffer from discrimination in healthcare settings. Showing that you care about and can address issues prevalent to their unique needs on your intake form may go a long way to helping them feel safe and nurtured.


Finally, not everything on your intake form should be about collecting information. You should also provide information to patients relevant to any legal information they are entitled to know, as well as any instructions or messages for their first or subsequent visits to your clinic.

The exact contents of your disclaimer will change depending on your practice, industry, and state laws, but generally they say something like this:

“The above information is accurate to the best of my knowledge. I authorize [your name or business name here] to bill my insurance provider. I understand that I am responsible for any remaining balance.”

Including any other pertinent legal or clinic information in this disclaimer can also help smooth over any future disagreements should they arise.

You should also add a custom message to the top of the form that thanks the patient for their time and gives them basic instructions about filling in information (which information is required, etc.) and how and where they can submit, review or change their form if necessary.

Even if you use the same message for every form, this personalizes the experience for the patient and helps them understand that you respect their time and that you want them to be fully informed about their care, even before it has begun.

Here are 5 more open-ended questions to include in your intake forms.

Final Thoughts

While most intake forms are fairly standard, there are things you can add to your form that may improve your overall care experience and help patients navigate their first visit with ease.

This includes disclaimers, instructions and particularly open-ended questions if possible. This way, patients can add any details not included on your form that may be relevant to your care, which may be something as simple as, “What else do we need to know?” or as inclusive as gender identity questions or mental health concerns.

You should also include branding information for your forms to reassure patients that they’re filling out the right information to the right practice (in addition to creating brand recognition for your clinic).

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