Patient and client intake — without the PDF email chain.
HIPAA-friendly intake forms with signature, file upload, and conditional sections. Replaces the 'fill out this PDF and email it back' antipattern that's been killing your intake completion.
Encryption + retention controls
TLS in transit, AES-256 at rest. Configurable retention windows so intake data deletes per your compliance policy.
Signature + file upload
Draw-to-sign on mobile + desktop. File upload for ID, insurance card, prior records. All in one guided flow.
Conditional sections
New patient vs returning. Adult vs pediatric. Insurance vs self-pay. Show only the sections relevant to each intake.
Sync to your EHR, SIS, or case-management tool
Webhook integration pushes intake data to Athenahealth, Epic, Salesforce Health Cloud, Clio, MyCase, or any system with a webhook endpoint. The receptionist stops re-keying data into the chart.
Pre-built patient & client intake forms.
Pick one, customize the copy, and ship — usually in under 10 minutes.
Browse all templatesTherapy & Counseling Intake
Sensitive one-question-at-a-time intake for therapists. PHQ-2 screen, modality preference, scheduling.
IVF & Fertility Pre-Screening
One-at-a-time fertility intake. Cycle history, prior attempts, AMH if known, scheduling.
Acne & Skin Concern Assessment
Skin-concern picker (acne, rosacea, pigmentation), severity rating, current routine capture.
LASIK Eye Surgery Consultation
Current prescription capture, dry-eye triage, screen-time risk factor, candidacy match.
Laser Hair Removal Consultation
Fitzpatrick skin-type swatches, target-area picker, hair-color filter, package quote.
Botox & Dermal Filler Consultation
Treatment-area face map, last-session timing, brand preference, calendar booking.
Rhinoplasty Consultation
Profile photo upload, primary vs. revision picker, breathing-issue triage.
Dental Implant Consultation
Treatment-image picker, missing-teeth count, bone-graft history, calendar booking.
Industries shipping patient & client intake forms.
Open the industry hub for sector-specific examples, templates, and tracking advice.
Patient & Client Intake Forms for agencies
Multi-workspace setup, per-client custom domains, and conversion analytics each client can see. Stop juggling Typeform seats — one platform handles every account.
Patient & Client Intake Forms for finance
Loan apps, insurance quotes, and advisor lead forms. Encrypted in transit + at rest, GDPR + CCPA controls, and server-side pixel tracking for every paid channel finance buys.
Patient & Client Intake Forms for fitness & wellness
Membership signups, class registration, and PAR-Q intake forms for gyms, yoga studios, and online coaches. Mobile-first, payment-ready, and tuned for the highest abandonment moment in fitness marketing.
Patient & Client Intake Forms for legal services
Multi-step intake, case evaluation, and consultation booking forms for law firms. Encryption, retention controls, and conflict-of-interest fields without the custom-dev bill.
Patient & Client Intake Forms for healthcare
HIPAA-friendly patient intake and appointment-booking funnels with server-side Meta, TikTok, and Google Ads tracking. Built for healthcare advertisers spending serious money on paid acquisition.
Patient & Client Intake Forms — common questions
Is it HIPAA-friendly?
Yes. Encryption in transit + at rest, audit logs, configurable retention, and BAA available on the Pro plan.
Can I capture digital signatures?
Yes. Signature fields render a draw-to-sign canvas on mobile + desktop with audit-trail metadata.
Will it accept insurance card uploads?
Yes. File-upload fields accept images and PDFs up to 25MB. Files are virus-scanned and stored encrypted.
Ship your patient & client intake form today.
Free while in beta · Server-side tracking included