Patient intake form generator
Choose the sections, print the form on your letterhead, or put a QR code at reception: the patient fills the same form on their own phone and shows you the PDF.
How to use it
Choose the sections
Contact details, emergency contact, insurance, conditions, medicines, allergies, family history and more, each one switch.
Print it blank
Two clean pages on your letterhead, with tick boxes and lines to write on, and a code for patients who would rather use their phone.
Or show the QR code
It opens this page in patient mode with your sections and clinic name. The patient fills it in and signs on the screen.
The patient saves the PDF
They send it to you or show it at reception. What they type never leaves their phone.
How the phone version keeps data private
The code carries your clinic’s name, phone and colour and the sections you chose, and nothing else. The form is filled and the PDF is made on the patient’s own phone; nothing is uploaded, to us or to you.
That also means the answers do not arrive anywhere by themselves. The patient sends or shows the PDF, and your team enters it into the file.
Save your design
Without saving, your clinic details, design and templates are cleared when the page reloads. Leave your email and they are kept in this browser from now on, and we will show you how they work in a Medicolize account, on every device and attached to patient files.
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Questions
Is the intake form free?
Yes, with no sign-up and no watermark.
Where do the patient’s answers go?
Nowhere by themselves. They stay on the patient’s phone until the patient saves the PDF and sends it to you or shows it at reception.
Can I choose which sections appear?
Yes. Switch sections on or off, edit the privacy line, and the printed form and the phone version both follow your choice.
Does the code need changing if I edit the form?
Yes. The code carries your choices at the moment you made it, so print it again after you change the sections or the clinic name.
Registered before they reach the desk
In Medicolize the patient completes their details and medical history before arrival, and what they enter lands on their record. Thirty minutes on your own clinic.