Popular search
Clinic intake form templates
48 free clinic intake form templates you can preview without an account. They span Healthcare & Clinical, Healthcare, Legal & Specialized, Fitness, Wellness & Coaching use cases and average around 18 questions each, so most teams find one that only needs light editing. Open any template to see every question it asks, the conditional logic it ships with, and the layouts it supports — then publish it on your own link, embed it on your site, or share it by QR code. Submissions land in your HelloForms inbox with email notifications, exports and analytics from the first response.
48 templates for “clinic intake form”
Chiropractic Intake Form
New patient intake for chiropractic care: the complaint and its history, previous manual treatment, general health screening, and consent to treat.🏥 Healthcare & Clinical19 questionsShort form — 19 questions across 2 pages.View templateDermatology Patient Intake Form
Dermatology intake covering the reason for the visit, how long it has been present, skin history, sun exposure and current skincare products used.🏥 Healthcare & Clinical15 questionsShort form — 15 questions across 2 pages.View templatePhysiotherapy Intake Form
Physio intake covering the injury or pain, how it started, what makes it worse, previous treatment, the activity goals, and consent to assess and treat.🏥 Healthcare & Clinical17 questionsShort form — 17 questions across 2 pages.View templateEye Exam Intake Form
Pre-exam optometry intake: recent vision changes, current glasses or lenses, screen and driving needs, eye history, and relevant general health.🏥 Healthcare & Clinical17 questionsShort form — 17 questions across 2 pages.View templateMental Health Intake Form
Three-page intake for mental health services: presenting concerns, history and support, risk and safety questions, and what the client wants from therapy.🏥 Healthcare & Clinical25 questionsMedium length — 25 questions across 3 pages.View templateNutrition Intake Form
Dietetic intake covering what the patient eats in a typical day, symptoms, relevant conditions and medication, and the goal they want to work on.🏥 Healthcare & Clinical19 questionsShort form — 19 questions across 2 pages.View templatePediatric Intake Form
Child intake completed by a parent: birth and development history, immunisations, current concerns, school and family context, and consent to treat.🏥 Healthcare & Clinical28 questionsMedium length — 28 questions across 3 pages.View templatePatient Intake Form
Medical history and background disclosure with a compliance focus.🩺 Healthcare, Legal & Specialized20 questionsShort form — 20 questions across 3 pages.View templateVeterinary New Patient Intake Form
Register a new animal patient with owner, species and medical history.🐾 Pets & Veterinary27 questionsMedium length — 27 questions across 4 pages.View templateTherapy Client Intake Form
Counselling intake covering history, goals, medication and emergency contact.🩺 Healthcare, Legal & Specialized19 questionsShort form — 19 questions across 4 pages.View templateTherapy Intake Form
New client intake for a therapy practice covering contact details, presenting concerns and session preferences.🧘 Fitness, Wellness & Coaching15 questionsShort form — 15 questions across 3 pages.View templatePatient Encounter Form
The visit record clinics bill from — reason, diagnosis codes, services and follow-up in one sheet.🩺 Healthcare, Legal & Specialized13 questionsShort form — 13 questions across 2 pages.View templateSpa Intake & Health History Form
Treatment-safe intake: conditions, contraindications, pregnancy and pressure preferences.💇 Beauty, Salon & Spa17 questionsShort form — 17 questions across 2 pages.View templateCoaching Intake Form
Everything you need before session one: goals, history, obstacles and working style.🧘 Fitness, Wellness & Coaching16 questionsShort form — 16 questions across 2 pages.View templateDental New Patient Intake Form
Dental history, insurance and consent in one pre-visit pack for new patients.🩺 Healthcare, Legal & Specialized20 questionsShort form — 20 questions across 4 pages.View templateHome Care Client Intake Form
In-home and elderly care assessment covering mobility, medications and daily schedule.🩺 Healthcare, Legal & Specialized20 questionsShort form — 20 questions across 4 pages.View templateClinic Appointment Request
Appointment request that gathers the reason for the visit, urgency, clinician preference and real availability so the diary can be filled in one reply.🏥 Healthcare & Clinical16 questionsShort form — 16 questions across 2 pages.View templateLab Test Requisition Form
Lab test requisition recording the ordering clinician, tests requested, reason for testing, fasting needs and the patient's preferred lab location.🏥 Healthcare & Clinical11 questionsShort form — 11 questions on a single page.View templateOrthodontic Consultation Form
One-page form for a first orthodontic consultation: main concern, prior treatment, jaw symptoms, and the times that suit an initial appointment.🏥 Healthcare & Clinical12 questionsShort form — 12 questions on a single page.View templatePatient Intake Questionnaire
Pre-appointment intake in two parts: contact and cover details, then reason for attending, current medication, allergies and relevant history.🏥 Healthcare & Clinical18 questionsShort form — 18 questions across 2 pages.View templatePatient Referral Form
Clinician-to-clinician referral with the reason for referral, relevant history, what has been tried, urgency and what the referrer is asking for.🏥 Healthcare & Clinical19 questionsShort form — 19 questions across 2 pages.View templatePatient Satisfaction Form
Fuller patient survey covering access, reception, facilities, the consultation, communication and whether the patient would recommend the clinic.🏥 Healthcare & Clinical17 questionsShort form — 17 questions across 2 pages.View templateSleep Study Intake Questionnaire
Sleep study intake covering sleep habits, snoring, breathing pauses, daytime sleepiness and current medications before a scheduled overnight sleep assessment.🏥 Healthcare & Clinical14 questionsShort form — 14 questions across 2 pages.View templateMedical Referral Form
Send patients to specialists with everything attached — reason, history, urgency and reports.🩺 Healthcare, Legal & Specialized13 questionsShort form — 13 questions across 2 pages.View template
Showing 24 of 48 templates
All 48 clinic intake form templates
- Chiropractic Intake Form
- Dermatology Patient Intake Form
- Physiotherapy Intake Form
- Eye Exam Intake Form
- Mental Health Intake Form
- Nutrition Intake Form
- Pediatric Intake Form
- Patient Intake Form
- Veterinary New Patient Intake Form
- Therapy Client Intake Form
- Therapy Intake Form
- Patient Encounter Form
- Spa Intake & Health History Form
- Coaching Intake Form
- Dental New Patient Intake Form
- Home Care Client Intake Form
- Clinic Appointment Request
- Lab Test Requisition Form
- Orthodontic Consultation Form
- Patient Intake Questionnaire
- Patient Referral Form
- Patient Satisfaction Form
- Sleep Study Intake Questionnaire
- Medical Referral Form
- Personal Training Intake & PAR-Q Form
- Caregiver Assessment Form
- Immunization Consent Form
- Nurse Triage Form
- Care Plan Review Form
- Dental Treatment Plan Consent Form
- Fall Risk Assessment Form
- Medical Equipment Loan Request Form
- Medication Review Form
- Pharmacy Transfer Request Form
- Substance Use Screening Form
- Consent to Treatment Form
- Quick Clinic Feedback
- Discharge Follow-Up Form
- Occupational Health Form
- Patient History Form
- Quick Cancellation Form
- Records Release Form
- Medical History Update Form
- Kennel Boarding Intake
- Dental Clearance Form
- HIPAA Patient Consent Form
- Medical History Form
- Patient Registration Form
Frequently asked questions
- Are these clinic intake form templates free?
- Yes. Every clinic intake form template on this page is free to preview and free to use on the Starter plan, including your own public form link and email notifications on each submission.
- Which clinic intake form template should I start with?
- Chiropractic Intake Form is the closest match for this search — it has 19 ready-made questions. If it asks for more than you need, delete any question in the builder; nothing is locked.
- Can I change the questions on a clinic intake form template?
- Every question is editable. Rename labels, mark fields required or optional, add conditional logic so follow-up questions only appear when they are relevant, and restyle the form to match your brand.
- How do I collect responses?
- Publish the form and share its link, embed it in a page, or print its QR code. Responses appear in your inbox in real time and can be exported to CSV or PDF at any time.
Related templates
More templates that fit this search.
Patient History Form
Full three-part medical history: personal and family background, systems review, lifestyle and medication, ready before a first consultation.🏥 Healthcare & Clinical24 questionsMedium length — 24 questions across 3 pages.View templateQuick Patient Check-In
One-screen arrival form for the waiting room: identity confirmed, reason for the visit noted, and any change since the last visit flagged for the clinician.🏥 Healthcare & Clinical9 questionsShort form — 9 questions on a single page.View templateConsent to Treatment Form
Records informed consent for a specific procedure: what was explained, alternatives discussed, questions answered, and the patient's signature.🏥 Healthcare & Clinical19 questionsShort form — 19 questions across 2 pages.View templateQuick Refill Request
Single-screen repeat prescription request with medication and dose, preferred pharmacy, collection or delivery and a note for the prescriber.🏥 Healthcare & Clinical10 questionsShort form — 10 questions on a single page.View templateMedication Review Form
A structured review of everything a patient takes, how well they are managing it, the side effects they notice, and what they would like changed.🏥 Healthcare & Clinical16 questionsShort form — 16 questions across 2 pages.View templatePre-Surgery Assessment
Pre-operative assessment covering fitness, anaesthetic history, medication to stop or continue, fasting instructions and arrangements for going home.🏥 Healthcare & Clinical27 questionsMedium length — 27 questions across 3 pages.View template
