Healthcare, Legal & Specialized · community shared

Dental Intake Form — shared by the community

Marta K. shared this 21-question build with 4 conditional rules already wired up. Test it below, then take a copy.

A ready-to-use healthcare, legal & specialized form for teams with a niche process that generic forms don't cover: 21 questions, 2 pages, 4 conditional rules.

Shared by
Marta K. · Practice manager
Questions
21
Replies
21
Copies taken
254
See the library version

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Live preview and test console

This is the real form. Answer it to test the 3 conditional rules — nothing is sent or stored.

Page 1 of 2 — Patient and insurance

Dental intake form

Is the patient a minor?

Include your country code.

1 question is hidden by conditional logic right now — change an answer above to reveal it.

Works for you? Take Marta K.'s copy into your own workspace — questions, rules and settings included.

Who this template is for

Dental Intake Form is built for teams with a niche process that generic forms don't cover who need to capture reproducible detail on first contact.

  • Teams with a niche process that generic forms don't cover working in healthcare, legal & specialized.
  • Teams who need to capture reproducible detail on first contact without writing code or paying for a custom build.
  • Anyone replacing requests that need three replies before work can start with one structured record per enquiry.
  • Respondents are the specific group this workflow serves — the form asks them 21 questions across 2 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of requests that need three replies before work can start and turns each submission into a record your team can act on immediately.

  • 10 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It collects a verified email address so replies and confirmations land.
  • It captures a phone number for urgent follow-up.
  • It records a signature you can keep as proof of agreement.
  • It pins the request to a specific date.
  • It captures a full postal address.
  • It allows multiple selections without free text.
  • Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Dental Intake Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

  • Features advanced show logic: if “Is the patient a minor?” is Yes, the form dynamically exposes “Parent or guardian name”. Otherwise that question never appears.
  • Features conditional hiding: if “Relationship of insurance subscriber to patient” is Self, “Subscriber's name” is removed from the form and is never submitted.
  • Features advanced show logic: if “Are you currently pregnant?” is Yes, the form dynamically exposes “Estimated due date”. Otherwise that question never appears.
  • Features conditional validation: if “Do you have any known drug allergies?” is Yes, “List known allergies” becomes mandatory before the form can be sent.
  • All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

What this form asks

Page 1 — Patient and insurance

  • Patient's full namerequired
  • Date of birthrequired
  • Is the patient a minor?required
  • Parent or guardian name
  • Phone number
  • Email addressrequired
  • Home address
  • Dental insurance company
  • Insurance ID or member number
  • Relationship of insurance subscriber to patientrequired
  • Subscriber's name

Page 2 — Health history and consent

  • Current medications
  • Do you have any known drug allergies?required
  • List known allergies
  • Do any of the following apply to you?
  • Are you currently pregnant?required
  • Estimated due date
  • Date of last dental cleaning or checkup
  • Reason for today's visitrequired
  • Agreementrequired
  • Patient or guardian signaturerequired

Conditional logic in this build

  • When “Is the patient a minor?” is Yes, show “Parent or guardian name”.
  • When “Relationship of insurance subscriber to patient” is Self, hide “Subscriber's name”.
  • When “Are you currently pregnant?” is Yes, show “Estimated due date”.
  • When “Do you have any known drug allergies?” is Yes, require “List known allergies”.

Questions about this shared form

How is this different from Dental New Patient Intake Form?

The two overlap in purpose; this version leans further into insurance subscriber routing and a general treatment consent, useful if your office wants both handled on one form.

Do returning patients need to fill this out again?

Typically only at intervals your practice sets, such as annually, or when insurance or medical history changes — most offices don't repeat it every visit.

Does the consent section cover procedures like extractions?

No — it covers general examination and treatment. Procedures with higher risk or sedation usually need their own specific consent form.

Can this replace a full medical history form from a physician?

No, it collects what a dental team needs clinically. For complex medical histories, coordinate directly with the patient's physician as needed.

Is the Dental Intake Form template free to use?

Yes. You can preview and test Dental Intake Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Dental Intake Form template ask for?

It asks 21 questions across 2 pages, 10 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Dental Intake Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this healthcare, legal & specialized form work?

4 conditional rules ship with the template: Features advanced show logic: if “Is the patient a minor?” is Yes, the form dynamically exposes “Parent or guardian name”. Otherwise that question never appears. Features conditional hiding: if “Relationship of insurance subscriber to patient” is Self, “Subscriber's name” is removed from the form and is never submitted. Features advanced show logic: if “Are you currently pregnant?” is Yes, the form dynamically exposes “Estimated due date”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the Dental Intake Form form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Dental Intake Form form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Is the signature on this form legally usable?

The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.

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