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20+ Patient Intake Form Templates

The patient intake form is given to the new and the existing patient in the hospital or the health care centre. The health care centre gives these forms to the patient to enter their basic detail in it and it saves time in the front desk as it the patient by themselves fill in the form so the receptionist gets time to attend the additional patient. The patient intake form templates are the kind of the forms that are provided to the patients to enter their basic details so that no mistakes are done.

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5-Steps to Create the Patient Intake Form

Step 1: The Basic Detail of the Patient

You must first download the form and then fill in with the personal detail such as the name, address, contact details and your prior medical history and all the necessary detail

Step 2: Insert the Emergency Contact Details

Insert in the emergency contact details so at the time of the emergency the hospital can contact that person.

Step 3: The Referral and the Adjunctive Care

The referred or the adjunctive detail such as the prior diet plan, the health care routine, exercise regime etc are the added detail should be mentioned in the form

Step 4: Add the Health Concern and Synonym

You must enter the health issues and the symptoms as it is considered to be an important part  when you’re filling a patient intake form

Step 5: Submit the Patient Intake Form

After filling in the form submit the form either offline or online whichever you prefer.

 20+ Patient Intake Form Templates

1. Patient Intake Form Template

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  • PDF

Size: 141.8 KB

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The patient fills the intake form as this is a part of the formality of any health care center or the hospital. After completing the formality only the patient will be admitted to the hospital for further treatment. It is a patient confidentiality agreement between the hospital and the patient. Doctors will go through your previous medical history by reading the details which you have put in the form. This usually mentions your medical history and simply by downloading this form template you can provide your basic health details in it.

2. Adult New Patient Intake Form Template

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  • PDF

Size: 408.6 KB

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The formalities are carried by both the new and the existing patient and as it is the rule of every hospital the patient has to give their details in the patient intake forms. And from there the physician come to know about the test and the medication that will be suitable for you. And most importantly if you have any allergies of any medication you can note in this form template. You can prefer this template as it is useful in maintaining your past medical history. With much preference download this template of the intake form.

3. Sample New Patient Intake Form Template

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  • PDF

Size: 52.6 KB

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The intake forms are like the questionnaire which is to be filled by the patient. And it ask questions regarding the previous medication and vaccination if done any. It is for both the new and the existing patient. The doctors keep a track on this records put by you in the form. Sometimes, based on the prior medication they start treating you. And if you are going for the medication in the health centre or hospital then you can download the patient intake template form in PDF.

4. Initial Patient Intake Form Template

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  • PDF

Size: 133.4 KB

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The basic and the medical detail of the patient are added in the intake forms which will act as the medical history for the hospital authority. The authority keeps the record of the patient’s medical history in their hospital archive. And it is confidential in nature and if any day there is the survey in the hospital then these records will help. Eventually, the intake form takes into account of the patients past medical details and also the most intricated details. This form is the complete description of your medical history and for this you should download it.

5. New Patient Intake Form Template

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  • PDF

Size: 210.3 KB

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The newly admitted patient have to fill in the form as for the first time the patient will be treated in that hospital and it need to keep the record of the patients details which will help in formulating the treatment for the patient. The treatment record are involved in the patient intake form. Download the template of the patient intake form that involve the detailed medical information of the patient according to that the patient health care plan is designed by the hospital authority.

6. Simple New Patient Intake Form Template

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  • PDF

Size: 162.2 KB

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Among the formalities, the filling up of the patient intake form is compulsory among the new and the existing patients. Obviously, it will make the record of the patient’s pre- medication detail along with the allergies due to some medication. By going through this medical form the doctor or the physician can take further treatment for you. Whenever you feel like can download this form template as it is the major track record of your medical history.

7. Management New Patient Intake Form Template

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  • PDF

Size: 407.3 KB

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The hospital management’s duty is to look after the file submitted by the patients during the first admission in the hospital. And the form which is filled at the entry in the hospital called the patient intake form which maintain the basic detail of the every new and existing patient which will tract down the essential in the form. This essential and the important information regarding the patient are kept intact in the sample form template. And it is available for the download option also.

8. New Patient Intake Form Example

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  • PDF

Size: 300.9 KB

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In the general sense, the patient takes the form to fill by itself and insert all his personal detail in the first place and then writes about the medical history if any. It is a form which quite detailed in nature which continues from the very basic information to the complicated information. Likewise, the doctors and the hospitals look at the file of each and every patient study their reports and then decide of how to treat them and what will be the procedure. The test and the medication is based on the intake form detail so it plays an important part in a patient’s life and to make use of this form, you can download the template of intake form which is easily viable and can be printed also.

9. Standardized Patient Intake Form Template

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  • PDF

Size: 85.9 KB

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In the standardized intake forms, the patient is requested to make the entry of his personal details like the name, qualification, contact details etc, photo id proof etc. Whereas, you will be asked few question regarding your treatment because it is necessary to take the patient’s question if he is mentally prepared to take the test. So, few questions need to be answerd according to your will. Then reading your patient note or intake form the physician will decide how they will approach for the treatment. It is your duty to put all the detail correctly in the form and it is important to download the template of intake form first then fill on the personal and treatment details.

10. Formal Patient Intake Form Template

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  • PDF

Size: 401.7 KB

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The patient intake form is nothing but the consent form from the patient asking its permission to agree with the treatment plan and procedure that the doctors will plan plan for.After giving the consent then the doctors will go through the file, then they will understand the matter and after that they will start the treatment procedure which will depend on the illness and the time period that you’re comfortable with. The patient intake form take the note of your detail in the broad way covering all the thing and so the template of the patient intake form is worth downloading.

11. Division of Community Patient Intake Form Template

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  • PDF

Size: 55.7 KB

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The patient intake forms are very few and most of this are used by the doctors, nurses, hospital staff etc. Nowadays the intake forms are available in the online portal which is much easy to use and if you are tech oriented person then you will know the procedure to fill in the online forms. Earlier,these form sample are available in the offline mode but now with the change of the time it has changed to the online mode where you can easily put your treatment detail and save it. In this process there is no fear to lose the records, once saved the document will be saved in the computer system. So, for that download the intake form template today itself and make your information safe and secure.

12. New Patient Intake Form Format

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File Format
  • PDF

Size: 2.6 MB

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In every hospitals the patient are given to add their details which is called the patient intake forms. These form also include the food habits, the diet plan, medications, exercise regime etc that you followed earlier prior starting the treatment. So, all this information are important to include in the patient intake form which will provide the hospital authority to plan treatment for you accordingly. And due to this reason also you must go and download the template form of patient intake which keeps in the record of the patient intact for further use.

13. Orthopedic New Patient Intake Form Template

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File Format
  • PDF

Size: 55.7 KB

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14. Patient History and General Intake Form Template

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File Format
  • DOC

Size: 15.3 KB

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The intake form is similar to the general patient form as they both contain the general information on the patient like the work and education history, the name, contact detail. It is always better to give correct and informative information because if you provide wrong details then your treatment process will go in the wrong direction so provide as much correct information as per your knowledge. The form template sample of the general intake is also should be downloaded to take the detail of your medical history.

15. Medicare Visit Patient Intake Form Template

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File Format
  • DOC

Size: 53.7 KB

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The intake forms can be customized which your patient will love to use as it is time saving and uses less effort. It can support each and every type of the question. This are easy to use and record your details and medical history. The intake forms are available online which are reliable and accessible to use so why you wasting time on the offline formalities. Just browse websites and download the patient intake form template online.

16. Basic Patient Intake Form Template

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  • PDF

Size: 156.9 KB

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There are many type of the forms available so you need o understand the basic patient intake form which are filled for acquiring services like the treatment in the clinic etc. These are both available offline where you can print the form, fill it and bring to the clinic during the visit and the other is the online form template example which you can fill in online and submit it in the hospital website. These forms are needed by the patient in order to avail the service. So, without much thinking of other form template download this patient intake form for you and your family.

17. Chiropractic New Patient Intake Form Template

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File Format
  • DOC

Size: 70.7 KB

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18. Trimetrics Patient Intake Form Template

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  • DOC

Size: 15.8 KB

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19. Previous Patient Intake Form Template

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  • DOC

Size: 20.0 KB

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20. Confidential New Patient Intake Form Template

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  • DOC

Size: 14.7 KB

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21. Patient Information and Insurance Intake Form Template

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  • PDF

Size: 730.9 KB

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