Healthcare Form Templates
Browse 206+ ready-to-use, HIPAA-ready form templates for every medical specialty. Fully customizable and ready in minutes.
206+ Templates · 8 Categories · Every Specialty
Showing 206 templates
Mental Health Intake Form
Specialized intake for behavioral health and therapy practices. Includes mood assessment (PHQ-9/GAD-7 style), treatment history, substance use screening, safety assessment, and therapy goals.
New Patient Intake Form
Comprehensive intake form with demographics, insurance, medical history, and consent. The most popular template for primary care, specialty clinics, and multi-provider practices.
Pediatric Intake Form
Child-specific intake form with developmental milestones, immunization records, birth history, school information, and parent/guardian details. Designed for pediatric and family medicine practices.
Acupuncture Intake Form
Acupuncture-specific intake covering chief complaint, TCM constitution assessment, pain mapping, lifestyle and emotional health, and treatment history. For licensed acupuncturists and integrative medicine clinics.
Addiction Medicine Intake Form
Addiction medicine intake covering substance use history, withdrawal risk assessment, medication-assisted treatment screening, mental health comorbidities, recovery support systems, and treatment readiness. For addiction medicine practices and MAT programs.
Allergy & Immunology Intake Form
Allergy and immunology intake with detailed allergy history, environmental triggers, reaction severity, immunodeficiency screening, and medication/immunotherapy history. For allergists and immunologists.
Annual Wellness Visit Form
Pre-visit form for annual physicals and wellness exams. Covers health changes since last visit, preventive screenings due, vaccination history, and current health goals.
Bariatric Surgery Intake Form
Bariatric surgery-specific intake covering weight history, BMI documentation, obesity-related comorbidities, prior weight loss attempts, nutritional assessment, and psychological readiness screening. For bariatric surgery programs and metabolic centers.
Behavioral Health Intake Form
Behavioral health intake covering presenting concerns, substance use screening, trauma history, psychosocial assessment, and treatment readiness. For behavioral health agencies, community mental health centers, and outpatient counseling practices.
Cardiology Intake Form
Cardiology-specific intake covering cardiac symptoms, chest pain assessment, heart disease risk factors, and cardiovascular history. Designed for cardiologists, electrophysiologists, and heart failure clinics.
Chiropractic Intake Form
Chiropractic-specific intake covering spinal complaints, pain patterns, lifestyle factors, previous chiropractic care, and X-ray/imaging history. Built for chiropractic and wellness practices.
Concierge Medicine Intake Form
Concierge medicine intake covering comprehensive health history, wellness goals, executive health screening, lifestyle assessment, family medical history, and care preferences. For concierge practices, direct primary care, and executive wellness programs.
Corporate Wellness Screening Form
Corporate wellness screening form for employers, occupational health providers, and workplace wellness programs. Captures employee demographics, biometric measurements, health risk factors, lifestyle assessment, medical conditions checklist, and participation consent.
Dental Patient Intake Form
Dental-specific intake covering oral health history, dental anxiety assessment, previous dental work, TMJ symptoms, and dental insurance verification. For general dentistry, orthodontics, and oral surgery.
Dermatology Intake Form
Dermatology-specific intake with skin concern history, sun exposure assessment, skin cancer screening questions, cosmetic treatment history, and photo upload for lesion documentation.
Endocrinology Intake Form
Endocrinology-specific intake covering diabetes management, thyroid disorders, hormonal symptoms, metabolic screening, and endocrine medication history. For endocrinologists and diabetes care centers.
ENT (Ear, Nose & Throat) Intake Form
ENT-specific intake covering hearing loss, sinus symptoms, throat complaints, balance disorders, and allergy history. For otolaryngologists, audiologists, and head and neck surgery practices.
Fertility Clinic Intake Form
Fertility clinic-specific intake covering reproductive history, menstrual cycle documentation, prior fertility treatments, partner information, and psychosocial screening. For reproductive endocrinology, IVF centers, and fertility practices.
Follow-Up Visit Form
Short pre-visit form for return patients. Captures treatment progress, symptom changes, medication updates, and new concerns since the last appointment.
Functional Medicine Intake Form
A comprehensive functional medicine patient intake form for integrative and holistic health practices, capturing health timeline, environmental exposures, diet and nutrition, supplements, sleep and stress assessment, gut health, and toxin exposure history.
Gastroenterology Intake Form
GI-specific intake covering digestive symptoms, bowel habit assessment, prior endoscopic procedures, liver and pancreatic history, and dietary factors. For gastroenterologists and hepatology practices.
Geriatrics Intake Form
Geriatrics-specific intake covering functional assessment, fall risk screening, cognitive evaluation, polypharmacy review, advance directives, and caregiver information. For geriatricians and senior care practices.
Hand & Upper Extremity Surgery Intake Form
Hand and upper extremity surgery intake covering hand and wrist symptoms, functional limitations, injury mechanism, nerve and tendon assessment, prior hand surgeries, and occupational demands. For hand surgeons and upper extremity specialists.
Hearing Aid Evaluation Form
Hearing aid evaluation and audiology intake form for audiologists, ENT practices, and hearing clinics. Captures hearing history, noise exposure, communication difficulties, current hearing aids, insurance verification, and appointment scheduling for hearing assessments.
Home Health Intake Form
Home health intake covering homebound status, functional assessment, fall risk, medication management, caregiver support, and home safety evaluation. For home health agencies, visiting nurse services, and home-based primary care programs.
Hormone Replacement Therapy Intake Form
A hormone replacement therapy intake form for HRT clinics and endocrine practices, capturing symptom assessment, hormone treatment history, current medications, lab results, treatment goals, and informed consent.
Hospice & Palliative Care Intake Form
Hospice and palliative care intake covering terminal diagnosis, symptom burden assessment, advance directives, caregiver information, spiritual and psychosocial needs, and goals of care. For hospice agencies, palliative care programs, and end-of-life care teams.
Infectious Disease Intake Form
Infectious disease-specific intake covering infection history, travel and exposure assessment, immunization records, antimicrobial therapy history, and immune status evaluation. For ID consultations, HIV clinics, and tropical medicine practices.
Insurance Verification Form
Collect insurance card photos (front and back), policy details, group number, and subscriber information. Enables pre-visit insurance verification to reduce claim denials.
IV Hydration Therapy Intake Form
IV hydration therapy intake form for mobile IV services, IV vitamin drip bars, and infusion wellness clinics. Covers health screening, allergies, current medications, hydration package selection, payment processing, and informed consent.
Ketamine Therapy Intake Form
Ketamine therapy intake form for clinics offering ketamine infusions and psychedelic-assisted therapy. Covers mental health history, contraindications screening, current medications, treatment goals, emergency contact, and informed consent for ketamine treatment.
Lactation Consultation Intake Form
Lactation consultation intake form for IBCLCs, breastfeeding consultants, and lactation support practices. Captures mother and baby information, birth details, feeding history, current concerns, medications, insurance verification, and appointment scheduling.
Male Fertility & Andrology Intake Form
Male fertility and andrology intake covering reproductive history, semen analysis results, hormonal assessment, sexual health, lifestyle factors, and prior fertility treatments. For reproductive urology, andrology, and fertility clinics.
Massage Therapy Intake Form
Massage therapy intake covering areas of tension and pain, pressure preferences, contraindication screening, treatment goals, and health history. For licensed massage therapists and bodywork practices.
Med Spa / Aesthetics Intake Form
Med spa intake covering aesthetic goals, skin type assessment, treatment history (injectables, laser, chemical peels), contraindication screening, and photo consent. For medical spas, aesthetics practices, and cosmetic dermatology clinics.
Nephrology Intake Form
Nephrology-specific intake covering kidney function history, CKD staging, dialysis access, fluid and diet management, and renal medication reconciliation. For nephrologists, dialysis centers, and kidney transplant programs.
Neurology Intake Form
Neurology-specific intake with headache assessment, seizure history, cognitive screening, neurological symptom checklist, and prior imaging review. For neurologists, headache centers, and epilepsy clinics.
OB/GYN Intake Form
Obstetrics and gynecology intake with menstrual history, pregnancy history, contraceptive use, gynecological symptoms, and reproductive health screening. For OB/GYN and women's health practices.
Occupational Therapy Intake Form
OT-specific intake covering functional limitations, ADL assessment, hand and upper extremity evaluation, workplace ergonomics, and treatment goals. For occupational therapists, hand therapy, and rehabilitation clinics.
Oncology Intake Form
Oncology-specific intake covering cancer diagnosis details, treatment history, chemotherapy regimens, symptom management, and psychosocial screening. For medical oncology, radiation oncology, and cancer centers.
Ophthalmology Intake Form
Eye care intake form with vision history, current symptoms, eye surgery history, contact lens/glasses prescription, and family eye disease history. For ophthalmology and optometry practices.
Orthopedics Intake Form
Orthopedic intake covering musculoskeletal complaints, injury mechanism, imaging history, joint function assessment, and surgical history. For orthopedic surgeons and sports medicine practices.
Pain Management Intake Form
Pain management intake with pain mapping, numeric rating scales, functional assessment, opioid risk screening, and interventional procedure history. For pain medicine, spine, and chronic pain clinics.
Pediatric Dentistry Intake Form
Pediatric dentistry intake covering child's dental history, oral development milestones, dental anxiety assessment, dietary habits, fluoride exposure, and parent/guardian consent. For pediatric dental practices and children's oral health programs.
Pelvic Floor Therapy Intake Form
Pelvic floor therapy intake form for pelvic floor physical therapists and pelvic rehabilitation specialists. Covers bladder and bowel symptoms, obstetric and surgical history, pain assessment, current medications, insurance verification, and treatment consent.
Physical Therapy Intake Form
PT-specific intake with injury mechanism, pain assessment (VAS scale), functional limitations, range of motion goals, and treatment expectations. For physical therapy, sports medicine, and rehabilitation clinics.
Plastic Surgery Intake Form
Plastic surgery intake covering cosmetic goals, procedure history, medical clearance, body dysmorphia screening, and photo consent. For plastic surgeons, cosmetic surgery centers, and reconstructive practices.
Podiatry Intake Form
Podiatry-specific intake covering foot and ankle symptoms, diabetic foot screening, gait assessment, footwear history, and prior podiatric procedures. For podiatrists, foot and ankle surgeons, and diabetic foot care clinics.
Psychiatry Intake Form
Psychiatry-specific intake covering psychiatric history, medication trials, substance use assessment, safety screening, and psychosocial evaluation. For psychiatrists, psychiatric nurse practitioners, and medication management clinics.
Pulmonology Intake Form
Pulmonology-specific intake covering respiratory symptoms, asthma and COPD assessment, smoking history, pulmonary function testing, and oxygen therapy documentation. For pulmonologists and respiratory care clinics.
Rheumatology Intake Form
Rheumatology-specific intake covering joint symptoms, autoimmune screening, morning stiffness assessment, prior biologic therapy, and functional limitations. For rheumatologists and autoimmune disease clinics.
Sleep Medicine Intake Form
Sleep medicine intake covering sleep habits, insomnia assessment, sleep apnea screening (STOP-BANG), Epworth Sleepiness Scale, CPAP history, and circadian rhythm evaluation. For sleep centers and pulmonary sleep clinics.
Sober Living Intake Form
Sober living and recovery housing intake form for halfway houses, sober living homes, and transitional housing programs. Captures personal history, substance use timeline, treatment history, current medications, emergency contact, and house rules consent agreement.
Speech Therapy Intake Form
Speech therapy intake covering communication concerns, speech and language development, swallowing assessment, voice disorders, and treatment history. For speech-language pathologists and communication disorder clinics.
Sports Medicine Intake Form
Sports medicine intake with athletic history, sport-specific injury assessment, training regimen, concussion history, and return-to-play goals. For sports medicine and athletic training facilities.
Travel Medicine Intake Form
Travel medicine-specific intake covering itinerary details, destination risk assessment, immunization history, malaria prophylaxis planning, and chronic disease travel considerations. For travel clinics and international health practices.
Urgent Care Intake Form
Streamlined intake for urgent care and walk-in clinics. Captures chief complaint, symptom timeline, vitals triage, allergies, and current medications in a fast-paced single-page format.
Urology Intake Form
Urology-specific intake covering urinary symptoms, prostate health assessment, kidney stone history, sexual health screening, and prior urologic procedures. For urologists and men's health clinics.
Vascular Surgery Intake Form
Vascular surgery-specific intake covering arterial and venous disease history, claudication assessment, wound evaluation, prior vascular interventions, and cardiovascular risk factor documentation. For vascular surgeons and endovascular specialists.
Veterinary Clinic Intake Form
A veterinary patient intake form for vet clinics and animal hospitals, capturing pet owner demographics, pet species and breed, vaccination history, current medications, allergies, and reason for visit.
Weight Loss Program Intake Form
A medical weight loss program intake form for weight management clinics and obesity medicine practices, capturing health history, current weight and BMI, diet and exercise habits, medications, allergies, conditions, treatment goals, and payment.
Wound Care Intake Form
Wound care intake covering wound history, etiology assessment, nutritional status, vascular evaluation, pain assessment, and prior wound treatment documentation. For wound care centers, vascular clinics, and home health wound management.
Allergy History Form
Focused allergy documentation form capturing drug, food, environmental, and contact allergies with reaction severity, onset, and management history. Critical for patient safety and prescribing decisions.
Dental History Form
Comprehensive dental history form capturing prior dental treatments, periodontal conditions, orthodontic history, oral surgery, TMJ symptoms, and dental anxiety assessment. Designed for dental and oral health practices.
Family Medical History Form
Structured family history form covering hereditary conditions across first and second-degree relatives. Organized by condition category for genetic risk screening and preventive care planning.
Genetic & Hereditary Screening Form
Genetic and hereditary screening form capturing family pedigree information, prior genetic test results, carrier status, pharmacogenomic data, and hereditary cancer or disease risk assessments. Designed for genetics counseling and genomic medicine programs.
Immunization History Form
Comprehensive immunization record capturing childhood and adult vaccinations, booster schedules, adverse reactions, and exemption documentation. Essential for preventive care and compliance tracking.
Medical History Questionnaire
Detailed medical history form covering past conditions, current medications, allergies, surgical history, and family medical history. Essential for new patients and annual updates.
Medication Reconciliation Form
Structured medication list form with dosage, frequency, prescribing physician, pharmacy information, and adherence assessment. Essential for transitions of care and preventing medication errors.
Mental Health History Form
Comprehensive mental health history form covering psychiatric diagnoses, medication history, therapy modalities, hospitalization records, substance use, trauma history, and current symptom assessment. Designed for behavioral health intake.
Occupational Health History Form
Occupational health history form documenting workplace exposures, prior work-related injuries, hazardous material contact, respiratory surveillance, and ergonomic assessments. Designed for occupational medicine and employee health programs.
Past Hospitalization Record Form
Structured hospitalization history form documenting prior inpatient admissions, emergency department visits, discharge diagnoses, procedures performed, and post-discharge complications. Essential for continuity of care across providers.
Pediatric Medical History Form
Gather complete medical history for pediatric patients including birth details, developmental milestones, childhood illnesses, and growth patterns. Tailored for pediatric and family medicine practices.
Pregnancy & Obstetric History Form
Detailed obstetric history form documenting gravidity, parity, prior pregnancies, delivery methods, complications, and neonatal outcomes. Essential for prenatal care planning and risk stratification.
Pregnancy & Obstetric History Form
Document detailed pregnancy and obstetric history including prior pregnancies, deliveries, and complications. Essential for OB/GYN practices managing prenatal and postpartum care.
Social History Questionnaire
Comprehensive social history questionnaire covering substance use, occupation, living situation, exercise, diet, social determinants of health, and behavioral risk factors. Essential for holistic patient assessment.
Surgical History Form
Detailed surgical history documentation covering past procedures, anesthesia reactions, complications, implanted devices, and blood transfusion history. Critical for pre-operative planning.
Travel Health History Form
Travel health history form documenting international travel destinations, endemic disease exposures, prophylactic medications, travel-related vaccinations, and post-travel symptom assessment. Used for travel medicine consultations.
HIPAA Consent & Authorization
Standard HIPAA privacy notice with treatment consent, communication preferences, and authorization for use of protected health information. Required for all new patients under HIPAA regulations.
Anesthesia Consent Form
Dedicated anesthesia consent covering anesthesia type options, risk acknowledgment, fasting instructions, and pre-anesthesia health screening. For anesthesiology departments and surgical centers.
Blood Transfusion Consent Form
An informed consent form for blood and blood product transfusions, covering transfusion risks, alternatives, and religious or personal objections.
Botox & Dermal Filler Consent Form
An informed consent form for Botox, dermal filler, and cosmetic injection treatments, covering treatment area selection, allergy screening, contraindication checklist, before-and-after photo documentation, and payment collection.
Chiropractic Treatment Consent Form
An informed consent form for chiropractic care covering spinal adjustments, manipulation techniques, and associated risks including rare but serious complications.
Cosmetic Procedure Consent Form
An informed consent form tailored for cosmetic and aesthetic procedures, addressing expected outcomes, risks, and post-procedure care requirements.
Dental Treatment Consent
Informed consent for dental procedures including restorative work, extractions, periodontal treatment, and oral surgery. Documents procedure-specific risks, anesthesia options, and post-care instructions acknowledgment.
Emergency Treatment Consent
Consent for emergency medical treatment when standard informed consent processes may be abbreviated. Covers treatment authorization, blood product consent, and emergency contact notification.
General Treatment Consent Form
A comprehensive consent form for general medical treatment, covering patient acknowledgment of procedures, risks, and alternatives.
Genetic Testing Consent Form
Informed consent for genetic and genomic testing covering test purpose, potential findings, implications for family members, data privacy, and right to decline results. Required for clinical and predictive genetic testing.
High-Risk Medication Consent
Informed consent for high-risk medications including biologics, controlled substances, and teratogenic drugs. Documents risk acknowledgment, monitoring requirements, and patient education completion.
High-Risk Medication Consent Form
Informed consent for high-risk medication therapy covering drug-specific risks, required monitoring, REMS program enrollment, contraindications review, and patient acknowledgment. For controlled substances, biologics, and teratogenic agents.
HIV Testing Consent Form
A consent form for HIV testing that addresses pre-test counseling acknowledgment, confidentiality protections, and the patient's right to decline testing.
Mental Health Treatment Consent Form
An informed consent form for mental health services covering therapy approaches, confidentiality limits, and patient rights in behavioral health treatment.
Minor Treatment Consent Form
Parental/guardian consent for treatment of minors. Includes treatment authorization, emergency medical authorization, and designated responsible adults for pickup and decision-making.
Organ Donation Consent Form
Informed consent for organ and tissue donation covering donor evaluation, surgical risks, psychological screening acknowledgment, and post-donation care. For transplant centers and organ procurement organizations.
Orthodontic Treatment Consent Form
An informed consent form for orthodontic treatment including braces, aligners, and retainers, covering treatment duration, risks, and patient responsibilities.
Pediatric Sedation Consent Form
Informed consent for pediatric procedural sedation covering sedation level, agent selection, NPO status verification, monitoring plan, and parent/guardian authorization. For pediatric procedures, imaging, and dental sedation.
Photo & Video Consent Form
Authorization for clinical photography and video recording. Covers purpose of documentation, usage rights, storage and retention, and patient right to revoke consent. For medical documentation and marketing.
Physical Therapy Consent Form
A consent form for physical therapy and rehabilitation services, covering treatment techniques, exercise programs, and patient participation expectations.
Radiation Therapy Consent Form
Informed consent for radiation therapy covering treatment modality, fractionation schedule, acute and late toxicities, fertility preservation discussion, and simulation procedures. For radiation oncology departments and cancer centers.
Radiology & Imaging Consent
Informed consent for diagnostic imaging procedures including CT scans, MRI with contrast, fluoroscopy, and interventional radiology. Covers radiation exposure, contrast agent risks, and pregnancy screening.
Research & Clinical Trial Consent
Informed consent for research participation covering study description, risks/benefits, voluntary participation, data use, and right to withdraw. Compliant with IRB and FDA requirements.
Stem Cell & Regenerative Medicine Consent Form
Stem cell therapy consent form for regenerative medicine clinics offering stem cell injections, PRP therapy, and biologic treatments. Covers treatment details, risks and benefits, contraindications, photo documentation, payment, and informed consent.
Substance Abuse Treatment Consent Form
A specialized consent form for substance abuse and addiction treatment programs, addressing 42 CFR Part 2 confidentiality protections and treatment modalities.
Surgical Consent Form
Informed consent for surgical procedures including procedure description, risk acknowledgment, anesthesia consent, and e-signature capture. Required documentation for pre-operative workflows.
Tattoo Removal Consent Form
Tattoo removal consent form for laser tattoo removal clinics and dermatology practices. Covers treatment area documentation, skin type assessment, photo authorization, risks acknowledgment, payment collection, and informed consent for laser procedures.
Telehealth Consent for Minors Form
A parental or guardian consent form for providing telehealth services to minor patients, covering technology requirements, privacy considerations, and limitations of virtual care.
Telehealth Consent Form
Consent for telehealth and virtual visit services. Covers technology requirements, privacy expectations, emergency protocols, and authorization for remote healthcare delivery.
Vaccination Consent Form
A consent form for vaccine administration that captures patient screening questions, vaccine information acknowledgment, and authorization to immunize.
ACE (Adverse Childhood Experiences) Screening
Standardized Adverse Childhood Experiences (ACE) screening questionnaire assessing 10 categories of childhood adversity. Used to identify trauma history and inform trauma-informed care approaches.
Activities of Daily Living (ADL) Assessment Form
Assess patient independence in activities of daily living (ADLs) and instrumental activities (IADLs) including bathing, dressing, mobility, meal preparation, and medication management.
AUDIT Alcohol Screening Form
WHO Alcohol Use Disorders Identification Test (AUDIT) screening form to identify hazardous drinking, harmful alcohol use, and potential alcohol dependence in patients.
Autism M-CHAT Screening Form
Modified Checklist for Autism in Toddlers (M-CHAT) screening form for early detection of autism spectrum disorder in children aged 16 to 30 months.
Blood Pressure Log Form
Structured blood pressure monitoring log for tracking systolic and diastolic readings, heart rate, and symptoms across multiple measurement sessions.
BMI & Body Composition Form
BMI calculation and body composition tracking form for monitoring weight status, waist circumference, and body fat percentage across patient visits.
CAGE Alcohol Screening Questionnaire
Classic four-question CAGE alcohol screening tool for rapid identification of potential alcohol use disorders. Simple, validated instrument widely used in primary care and emergency settings.
Concussion SCAT Assessment Form
Sport Concussion Assessment Tool (SCAT) form for standardized sideline and clinical evaluation of suspected concussions following head injuries.
CRAFFT Adolescent Substance Abuse Screening
CRAFFT 2.1 screening tool designed for adolescents aged 12-21 to identify substance use risks including alcohol, cannabis, and other drugs. Validated brief screening instrument recommended by the AAP.
DAST-10 Drug Abuse Screening
Drug Abuse Screening Test (DAST-10) for rapid identification of drug use disorders. Ten validated yes/no questions assessing drug-related problems, consequences, and loss of control over the past 12 months.
DAST-10 Drug Abuse Screening Test
DAST-10 Drug Abuse Screening Test for identifying drug use problems in clinical settings. Ten validated yes/no questions with structured scoring and severity-level classification.
Eating Disorder Screening Form
Eating disorder screening form based on EAT-26 style validated questions for identifying anorexia, bulimia, binge eating, and disordered eating patterns. Includes weight history, body image assessment, dietary pattern evaluation, and emergency contact collection.
Edinburgh Postnatal Depression Scale Form
Edinburgh Postnatal Depression Scale (EPDS) screening form for identifying postnatal and postpartum depression in new mothers during the perinatal period.
Epworth Sleepiness Scale
Epworth Sleepiness Scale (ESS) questionnaire measuring daytime sleepiness across eight common situations. Validated screening tool for identifying excessive sleepiness and potential sleep disorders.
Fall Risk Screening Form
Fall risk assessment for older adults covering fall history, medication review, mobility assessment, environmental hazards, and fear of falling. Based on CDC STEADI protocol for fall prevention.
Functional Capacity Evaluation Form
Functional Capacity Evaluation (FCE) form for assessing a patient's physical functional abilities, work capacity, and activity tolerance for disability and return-to-work determinations.
GAD-7 Anxiety Screening
Standardized GAD-7 anxiety screening questionnaire with structured scoring, severity levels, and clinical guidance. Validated tool for generalized anxiety disorder screening in clinical settings.
Geriatric Depression Scale (GDS) Form
Geriatric Depression Scale (GDS) screening form designed specifically for older adults, using age-appropriate yes/no questions to identify depressive symptoms in elderly patients.
Glucose Monitoring Log Form
Blood glucose monitoring log for tracking fasting and postprandial glucose levels, insulin dosing, and diabetes management metrics over time.
Nutritional Assessment Form
Evaluate patient nutritional status, dietary habits, and risk factors for malnutrition or nutritional deficiencies with this comprehensive dietary assessment form.
Pain Assessment Form
Comprehensive pain evaluation form using the Visual Analog Scale (VAS), body pain diagram, and functional impact assessment for acute and chronic pain patients.
PCL-5 PTSD Screening Checklist
PTSD Checklist for DSM-5 (PCL-5) screening instrument with 20 items assessing post-traumatic stress symptoms across four DSM-5 symptom clusters. Validated tool for PTSD screening, diagnosis, and treatment monitoring.
Pediatric Developmental Screening Form
Age-appropriate developmental milestone screening form for pediatric patients, assessing communication, motor skills, social-emotional development, and cognitive milestones.
PHQ-9 Depression Screening
Standardized PHQ-9 depression screening questionnaire with scoring, severity interpretation, and clinical action recommendations. Validated screening tool used in primary care and behavioral health.
PTSD Checklist (PCL-5) Screening
PCL-5 screening questionnaire for post-traumatic stress disorder based on DSM-5 criteria. Twenty validated items assessing intrusion, avoidance, cognition/mood changes, and arousal/reactivity symptoms.
Social Determinants of Health Screening
SDOH screening covering food security, housing stability, transportation access, financial strain, personal safety, and social isolation. Based on CMS-recommended screening tools for value-based care.
STOP-BANG Sleep Apnea Screening
STOP-BANG questionnaire for rapid screening of obstructive sleep apnea risk. Eight-item validated tool assessing snoring, tiredness, observed apneas, blood pressure, BMI, age, neck circumference, and gender.
STOP-BANG Sleep Apnea Screening
STOP-BANG questionnaire for obstructive sleep apnea risk screening. Eight validated yes/no questions assessing snoring, tiredness, observed apnea, blood pressure, BMI, age, neck circumference, and gender.
Substance Use Screening (CAGE-AID)
Substance use screening based on CAGE-AID adapted for drugs and alcohol. Includes frequency assessment, impact evaluation, and readiness for change. For primary care and behavioral health screening.
Vanderbilt ADHD Assessment
Vanderbilt ADHD Diagnostic Assessment Scale for evaluating attention deficit hyperactivity disorder symptoms in children and adolescents. Covers DSM-5 inattention, hyperactivity-impulsivity, and performance domains.
Vanderbilt ADHD Assessment Screening
Vanderbilt ADHD Assessment Scale for evaluating attention deficit hyperactivity disorder symptoms in children ages 6-12. Parent-reported questionnaire covering inattention, hyperactivity, and behavioral comorbidities.
Advance Directive Form
Document patient advance directive preferences including healthcare proxy designation, living will provisions, and end-of-life care wishes.
Appointment Request Form
Let patients request appointments online by specifying their preferred dates, times, providers, and reason for visit to streamline your scheduling workflow.
Clinical Trial Enrollment Form
Enroll patients in clinical research studies by collecting eligibility criteria, medical history, informed consent, and study-specific demographic data in a structured multi-page form.
Emergency Contact Form
Collect primary and secondary emergency contact details along with authorized representatives for medical decision-making and information release.
Group Visit Registration Form
Register patients for group medical visits, shared appointments, and wellness sessions by collecting attendee information, health topics of interest, and participation consent.
Medical Records Release Form
Authorize the release of protected health information to specified recipients with HIPAA-compliant consent and detailed scope of disclosure.
Medical Second Opinion Request Form
Medical second opinion request form for patients seeking an independent review of their diagnosis or treatment plan. Captures current diagnosis, treatment history, medical records upload, insurance verification, appointment booking, and consent for records release.
Medication Refill Request Form
Allow patients to submit medication refill requests electronically, reducing phone call volume and streamlining prescription management workflows.
Motor Vehicle Accident Intake Form
Document motor vehicle accident details, injury specifics, and auto insurance information for comprehensive personal injury evaluation and treatment.
No-Show Policy Acknowledgment Form
Ensure patients understand and acknowledge your practice's no-show and late cancellation policies before their first appointment.
Patient Demographics Form
Collect essential patient demographic information including personal details, contact information, and insurance data for new patient registration.
Patient Portal Registration Form
Enroll patients in your online patient portal by collecting account setup information, identity verification, and communication preferences.
Patient Transfer Request Form
A patient transfer request form for healthcare practices, capturing current and receiving provider details, specific records requested, insurance information, and HIPAA-compliant consent for release of medical records.
Referral Request Form
Streamline the referral process by collecting all necessary patient information and clinical details needed to coordinate specialist consultations.
School Physical Examination Form
Complete school physical examination registration including student demographics, immunization history, medical conditions, and parent/guardian authorization. Meets standard school entry requirements.
School Physical Examination Form
Complete school-required physical examination documentation including student demographics, immunization history, medical conditions, and provider clearance for school attendance.
Self-Pay Patient Registration Form
Register self-pay and uninsured patients with transparent fee disclosure, payment method collection, and financial screening to streamline out-of-pocket billing from the first visit.
Sports Physical Clearance Form
Evaluate and clear student athletes for sports participation with a pre-participation physical examination form covering cardiac screening, musculoskeletal assessment, and medical history.
Workers' Compensation Intake Form
Capture detailed workplace injury information, employer details, and claim data required for workers' compensation evaluation and documentation.
Braden Scale Pressure Injury Risk Assessment
A standardized pressure injury risk assessment form using the Braden Scale, evaluating sensory perception, moisture, activity, mobility, nutrition, and friction/shear to determine patient risk level.
Braden Scale Pressure Injury Risk Assessment
A standardized Braden Scale assessment form for evaluating pressure injury risk across six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
Cardiac Risk Assessment Form
A comprehensive cardiac risk assessment form incorporating ASCVD risk calculation, Framingham risk factors, cardiac symptom evaluation, and cardiovascular disease prevention planning.
Cognitive Assessment (MMSE/MoCA)
A structured cognitive assessment form based on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) frameworks, evaluating orientation, memory, attention, language, and visuospatial function.
Fall Risk Assessment (Morse Fall Scale)
A standardized fall risk assessment form based on the Morse Fall Scale, evaluating history of falling, secondary diagnoses, ambulatory aids, IV access, gait, and mental status to stratify patient fall risk.
Functional Independence Measure (FIM)
A comprehensive Functional Independence Measure (FIM) assessment form evaluating self-care, sphincter control, transfers, locomotion, communication, and social cognition to quantify functional disability and rehabilitation progress.
Infertility / IVF Intake Form
A detailed fertility treatment intake form covering reproductive history, menstrual and obstetric history, previous treatments, partner information, and treatment goals for IVF and assisted reproduction.
Mental Status Examination (MSE)
A comprehensive Mental Status Examination (MSE) form documenting appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment for psychiatric evaluation.
Neonatal Assessment Form
A comprehensive neonatal assessment form capturing APGAR scoring, gestational age determination, newborn physical examination, vital signs, and initial feeding and bonding documentation.
Orthopedic Injury Assessment Form
A structured orthopedic injury assessment form documenting mechanism of injury, musculoskeletal examination findings, neurovascular status, imaging results, and orthopedic treatment planning.
Pediatric Asthma Severity Assessment
A pediatric asthma severity and control assessment form evaluating symptom frequency, nighttime awakenings, rescue inhaler use, activity limitation, and lung function to classify asthma severity and guide treatment.
Post-Operative Assessment Form
A structured post-surgical recovery monitoring form that tracks pain levels, wound status, mobility, potential complications, and discharge readiness criteria.
Pre-Operative Assessment Form
A comprehensive pre-surgical evaluation form covering medical history, anesthesia risk classification, medication review, laboratory results, and overall surgical readiness.
Rehabilitation Intake Form
A comprehensive rehabilitation intake form for patients entering inpatient or outpatient rehab programs, covering functional status, mobility, cognition, and individualized recovery goals.
Respiratory Assessment
A comprehensive respiratory assessment form evaluating breathing pattern, lung sounds, oxygen saturation, airway status, cough characteristics, and respiratory interventions for patients with pulmonary conditions.
Skin & Dermatology Assessment Form
A detailed dermatologic assessment form for documenting skin lesion characteristics, full-body skin examinations, ABCDE criteria evaluation, and dermatologic treatment plans.
Stroke Assessment (NIH Stroke Scale)
A structured stroke assessment form based on the NIH Stroke Scale (NIHSS), evaluating level of consciousness, motor function, sensory deficits, visual fields, language, and neglect to quantify stroke severity.
Suicide Risk Assessment (Columbia Protocol)
A structured suicide risk assessment form based on the Columbia Suicide Severity Rating Scale (C-SSRS), evaluating suicidal ideation severity, intent, plan, behavior history, and protective factors.
Swallowing & Dysphagia Assessment Form
A comprehensive swallowing and dysphagia assessment form documenting oral motor examination, swallowing trials across IDDSI texture levels, aspiration risk indicators, and diet texture recommendations.
Wound Assessment & Documentation
A comprehensive wound assessment and documentation form for evaluating wound type, dimensions, tissue characteristics, drainage, and healing progress across all care settings.
Assignment of Benefits Form
Authorize insurance reimbursement payments to be sent directly to the healthcare provider, ensuring faster claims processing and reducing out-of-pocket burden on patients.
Charity Care Application Form
Process patient applications for charity care and financial assistance programs by collecting income verification, household details, hardship documentation, and eligibility acknowledgment.
Financial Agreement Form
Establish clear financial expectations between patients and your practice by documenting payment responsibility, billing policies, and available payment plan options.
Good Faith Estimate Form
Provide uninsured and self-pay patients with an itemized, upfront estimate of expected charges for scheduled healthcare services in compliance with the No Surprises Act.
Patient Refund Request Form
A patient refund request form for healthcare billing departments, capturing original payment details, reason for refund, supporting documentation, and preferred refund method for efficient processing.
Payment Plan Agreement Form
Formalize installment payment arrangements between patients and your practice by documenting the total balance owed, monthly payment amount, schedule, accepted methods, and default terms.
Prior Authorization Request Form
Prior authorization request form for submitting insurance pre-authorization requests for medications, procedures, and specialist referrals. Captures patient demographics, insurance details, clinical justification, diagnosis codes, and supporting documentation uploads.
Prior Authorization Request Form
Streamline the insurance prior authorization process for medical procedures, diagnostic tests, and medications with a structured request form that captures all required clinical and administrative details.
Sliding Scale Fee Application
Application form for patients requesting income-based sliding scale fees, collecting household size, income documentation, employment status, and hardship details to determine eligibility for reduced-cost care.
Superbill / Encounter Form
Standardized superbill and encounter form for documenting services rendered, diagnosis codes, procedure codes, and charges at the point of care. Streamlines claims submission and reduces billing errors for medical practices.
Superbill / Encounter Form
Document encounter details, diagnosis codes, and procedure codes on a standardized superbill to streamline insurance claim submission and patient billing after each visit.
Annual Wellness Check-In Survey
Yearly wellness survey capturing patients' self-reported health status, lifestyle habits, preventive care compliance, mental health screening, and health goals. Supports proactive care planning and population health management.
Appointment Feedback Survey
Appointment-focused feedback survey covering scheduling ease, check-in process, wait times, and overall office experience. Helps practices optimize patient flow and operational efficiency.
Caregiver Burnout Assessment Survey
Caregiver burnout and stress assessment survey based on Zarit Burden Interview style questions. Evaluates caregiver burden, emotional exhaustion, caregiving situation, self-care habits, support needs, and resource referral consent for family and professional caregivers.
Discharge Survey
Discharge feedback survey for patients leaving a hospital or facility stay. Covers discharge instruction clarity, medication understanding, follow-up planning, and readiness to manage care at home.
Employee Health & Wellness Survey
Comprehensive employee health and wellness survey designed for healthcare organizations to assess staff physical health, mental wellbeing, workplace ergonomics, and access to wellness resources. Helps identify burnout risks and improve employee retention.
Health Literacy Assessment Survey
Health literacy assessment survey evaluating patients' ability to understand medical instructions, navigate the healthcare system, and make informed health decisions. Based on validated health literacy screening approaches.
Net Promoter Score (NPS) Survey
Streamlined Net Promoter Score survey measuring patient loyalty through the standard 0-10 recommendation question, supplemented with reason drivers and open comments. Quick to complete with high response rates.
New Patient Onboarding Feedback Survey
Gather feedback from new patients about their onboarding experience including registration ease, staff helpfulness, wait times, communication clarity, and overall first impressions. Essential for optimizing the new patient journey.
Patient Satisfaction Survey
Comprehensive patient satisfaction survey measuring overall care quality, provider communication, office environment, and likelihood to recommend. Aligned with CAHPS standards for healthcare quality improvement.
Post-Visit Follow-Up Survey
Post-visit follow-up survey to check on patient status, medication adherence, symptom changes, and care plan compliance after a recent appointment. Supports proactive care continuity.
Provider Rating Survey
Provider-focused rating survey measuring individual clinician performance across communication, empathy, clinical competence, and trust. Supports provider development and performance reviews.
Referral Feedback Survey
Referral experience survey evaluating how smoothly patients transitioned from their primary provider to a specialist. Covers referral coordination, wait times, and information transfer quality.
Staff Satisfaction Survey
Measure staff satisfaction across key workplace dimensions including leadership, communication, compensation, professional development, and team dynamics. Built for healthcare organizations seeking to improve retention and workplace culture.
Telehealth Experience Survey
Telehealth-specific survey evaluating the virtual visit experience including technology usability, audio/video quality, provider engagement, and overall satisfaction with remote care delivery.
Telehealth Readiness Assessment Survey
Assess patient readiness for telehealth visits by evaluating technology access, device availability, internet connectivity, digital literacy, and comfort level with virtual healthcare. Helps practices identify patients who need support before their first virtual visit.
Treatment Outcome Survey
Patient-reported outcome survey measuring treatment effectiveness, symptom improvement, functional status changes, and overall satisfaction with treatment results. Supports PRO data collection for quality programs.
Wait Time Feedback Survey
Focused survey on patient wait times throughout the visit, from arrival through check-out. Identifies bottlenecks in patient flow and measures the impact of wait times on overall satisfaction.
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Why use healthcare form templates?
Healthcare form templates save your practice hours of setup time. Instead of building intake forms from scratch, start with a template that already includes the right fields for your specialty — from patient demographics and insurance capture to medical history checklists and e-signature consent.
Every Formisoft template is designed specifically for healthcare. That means HIPAA-ready field types, proper data handling for protected health information (PHI), and built-in compliance features like audit logging and encryption. Unlike generic form builders, our templates understand healthcare workflows out of the box.
All templates are fully customizable. Add or remove fields, rearrange pages, set up conditional logic (like showing medication details only when a patient indicates they take medications), and apply your practice’s branding — your logo, colors, and fonts. Or skip templates entirely and build with AI.
