Patient Intake Form - With Family Medical History

A Patient Intake Form is a written statementfilled out by the patient to allow a medical facility to obtain accurate clinical data and be better equipped to care for the person in question.

Alternate Name:

• Patient Registration Form.

What Is a Patient Registration Form?

Whether the patient visits the clinic for a regular check-up or arrives at the hospital with an injury or sudden illness, a Patient Intake Form will help a medical administrator or physician figure out what kind of initial treatment the patient requires and determine the necessity of referral. This document will improve the patient experience and speed up the paperwork process and assist doctors and nurses who will know the summary of the client's medical needs prior to the visit.

You can download a Patient Intake Form template through the link below. To properly collect the medical history of the patient and describe the symptoms they have, you need to identify them and add their contact details, include the telephone number of the emergency contact, record the specifics of their insurance coverage, list questions about the patient's current condition they can answer with a simple "yes" or "no", ask them about underlying health issues, allergies, and medication they take, and provide free space to let the individual speak about their illness or injury in their own words. Additionally, you can ask the patient to authorize urgent medical procedures or even surgery giving their consent to immediate medical intervention.

Haven't found the form you're looking for? Take a look at the related forms below:

• Patient Referral Form;
• Doctor Release Form;
• Medical Consent Form.