Patient & Client Intake Forms for healthcare.
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.
Why healthcare teams ship patient & client intake forms on AnimationFunnel.
The form-type playbook, applied to the healthcare buyer journey.
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.
Compliant funnels. Real conversions.
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.
Compliance baked in, not bolted on
Encryption in transit and at rest, configurable retention windows, full access audit logs, and BAAs on Pro. Your compliance review takes hours, not weeks.
Server-side tracking that survives healthcare ad rules
Meta, TikTok, and Google Ads CAPIs fire from our servers — bypassing ad-blockers, ITP, and the strict consent banners patients click through. Recover the 25–40% of conversions client-side pixels lose.
Route by case type before submit
Conditional logic separates new patients, returning patients, and emergencies into the right intake flow. Hot leads route to the booking team in real time via webhook or CRM sync.
Healthcare patient & client intake forms templates.
Pre-built and ready to fork. Customize the copy and ship in minutes.
Browse all templatesTherapy & Counseling Intake
Sensitive one-question-at-a-time intake for therapists. PHQ-2 screen, modality preference, scheduling.
Laser Hair Removal Consultation
Fitzpatrick skin-type swatches, target-area picker, hair-color filter, package quote.
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.
Botox & Dermal Filler Consultation
Treatment-area face map, last-session timing, brand preference, calendar booking.
Patient & Client Intake Forms for healthcare — 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.
More for healthcare
Ship your healthcare patient & client intake form today.
Free while in beta · Server-side tracking included