Patient intake forms for small practices
Take the administrative half of intake online: contact details, appointment type, availability and practice policies, one question per screen. Unlimited responses on the free plan, and straight with you about where Upform stops.
Not for protected health information. Read the next section before you build anything.
Before anything else
Upform is not HIPAA compliant
This page is written for the part of intake that is not PHI: scheduling, contact details, general enquiries, practice policies and the admin a front desk would handle. It is also written for coaches, wellness practitioners and private practices outside the US, whose intake often sits under entirely different rules. Check what applies where you practice before you publish. We make form software; we are not your compliance advisor.
1 →
What kind of appointment do you need?
Pick one. The rest of the form changes to match.
21
Question types, all on the free plan
∞
Enquiries a month, never capped
20
Logic operators for branching
$0
To run your booking forms
What a non-clinical intake form covers
A non-clinical intake form is the administrative half of taking on a new patient or client: who they are, how to reach them, what they are booking and what they are agreeing to. It is the paperwork a receptionist would hand over on a clipboard, minus anything a clinician would later write in a chart.
That split matters because the two halves sit under different rules. In the US, the clinical half is protected health information and belongs in a system whose vendor has signed a BAA with you. The administrative half is usually ordinary personal data, and a general form builder is a reasonable place for it, provided you keep the line clean and your own regulator agrees.
The practical test: if an answer would end up in a clinical record, it does not belong on this form. If it would end up in a calendar or a contact list, it probably does. When you are unsure, split intake in two and send the clinical half from the system that already holds your records.
Who this actually fits
- Scheduling and enquiries. Practices whose first-contact form is a booking request or a general question, with clinical detail taken later in person.
- Coaching and wellness. Coaches, trainers, nutritionists and wellness practitioners whose intake is not regulated health data where they work.
- Private practice outside the US. Clinics working to GDPR or local rules rather than HIPAA, who have taken their own advice on what they can collect.
- The front-desk layer. Clinics that want new-patient admin online and keep history, notes and results in their practice management system.
- Everything after the appointment. Feedback, referral sources, class sign-ups and rebooking, none of which needs clinical detail.
Built as a conversational form, eight administrative questions become eight quick screens with a progress bar, finished on a phone rather than on a clipboard in your waiting room.
The field list
What to ask, and what to leave out
Two lists worth pinning above the desk. The first is a complete non-clinical intake form. The second turns a simple booking form into a problem you did not need.
Ask these, with this question type
- Appointment type, as a Single Choice or Dropdown. Ask it first so the rest of the form can branch on the answer.
- Full Name, so the booking and your records match.
- Email and Phone Number. The phone field carries a country flag and dial code.
- Preferred days and times, as a Multiple Choice with a selection limit.
- Earliest date you could come in, as a Date field. One question that saves three emails.
- Address, with only the sub-fields you actually use switched on.
- How did you hear about us, as a Single Choice. The question most practices skip and later wish they had.
- Your cancellation and fee policy, as a Statement step, then a Yes/No confirming they read it.
Keep these off the form
- Symptoms, the presenting complaint, or a written-out reason for the visit
- Diagnoses, past or present, and anything about mental health
- Medication, allergies and immunization history
- Treatment history, referral letters and clinical notes
- Insurance member and policy numbers, or any claims detail
- File Uploads of an insurance card, an ID document or anything clinical
- Social security, national insurance or health service numbers
- Any question whose answer a clinician would record in a chart
Upform has no signature field. A policy agreement is a Statement step followed by a Yes/No, timestamped with the rest of the response. If you need a legally executed signature, use an e-signature tool for that step.
The respondent's side
Intake people finish before they arrive
A clipboard at the desk is eight fields, a biro that does not work and a queue behind you. The same eight questions, one per screen on a phone, get answered the evening before and are waiting when you open.
- One question per screen, with a progress bar shown as a bar, dots or a percentage.
- Enter to continue, arrow keys to step back, 1–9 and A–Z to pick a choice, Y and N for yes-no.
- Full-width tap targets and a sticky back and next bar on mobile, where most of these get filled in.
- Your logo, colors, Google font and corner radius, held behind a short branded overlay so nothing flashes unstyled.
5 →
What address should we keep on file?
Street, city and postcode. Switch off the sub-fields you don't need.
The Address question with three sub-fields switched on. One of 21 types, all free.
1 →
What kind of appointment do you need?
Conditional logic
Branch by appointment type
A first visit, a follow-up and a general enquiry need different questions. Put all three sets on one form and everybody gets the longest version. Branch on question one instead, and each person answers only their own path.
- 20 operators, including is any of, is none of, is before, is after and is answered.
- Four actions: show a question, hide it, jump ahead, or end the form politely.
- Each rule is a flat AND/OR group, so whoever runs your front desk can read it out loud and check it.
- One form and one link for every appointment type, with the type recorded against each response.
Upform routes, it does not calculate. There is no scoring engine, so a triage score or any questionnaire that adds up points is out of scope, and a form that needs one is usually clinical anyway.
See conditional logicCollect only what you need
Data minimization is the whole discipline here. Every field you add is something you now have to store, secure, explain and eventually delete, and on an intake form it is also one more screen between a person and their appointment. Ask what you will use this week and leave the rest to the consultation, where it is recorded properly.
Say on the form why you are asking, who sees the answers and how long you keep them. One Statement step before the questions does this better than a privacy policy nobody opens. Then keep a retention habit: export what you need, and delete responses once they have served their purpose.
On the storage side, forms stay private until you publish them, every table is protected by row-level security with roles checked through a security-definer function, uploads are scoped to the form that collected them, and public submissions run through invisible reCAPTCHA v3. Integrations connect with your own account over OAuth, so a response lands in your Google Sheet, not a shared one. Our guide to GDPR-compliant forms covers consent wording, lawful basis and retention, and the security page covers storage and access.
Templates
Start from a template
Preview any of them live, then clone onto your account and cut the questions back to what your practice uses. All free, all editable.
What brings you in today?
Patient intake form
Contact details, appointment type, preferred times and a policy step. The clinical questions are deliberately absent.
HealthcareWhich day suits you best?
Booking form
Appointment type, earliest date, preferred slots and contact details, branched so nobody answers a question meant for someone else.
EventsWhat can we help with?
Contact form
The three-field baseline for a practice website. Add one appointment-type qualifier and it becomes an enquiry form.
Lead generationMore in the template gallery, including the client intake form for practices whose intake looks more like onboarding. Responses land in a table with search, filters and CSV export, or go straight to Google Sheets on your own account.
Frequently asked questions
Is Upform HIPAA compliant?
No. Upform does not sign a Business Associate Agreement and holds no healthcare certification. If you handle protected health information under US HIPAA rules, use a HIPAA-eligible form provider that will sign a BAA with you. Upform is built for the non-clinical side of intake: scheduling, contact details, general enquiries and practice admin.
Can I use Upform for a patient intake form at all?
It depends on what the form collects and where you practice. Plenty of intake is purely administrative: name, contact details, appointment type, availability, how someone heard about you, and agreement to a cancellation policy. If your form stays on that side of the line and your own rules allow it, Upform is a reasonable place for it. The moment a question touches symptoms, diagnosis, medication or treatment history, move that part to a system built for health records.
What about GDPR and practices outside the US?
HIPAA is a US law. Practices elsewhere work to different rules, usually GDPR plus national health data and professional obligations, and health data is a special category under GDPR that needs its own lawful basis. Upform gives you the practical controls: forms stay private until you publish, every table has row-level security, and uploads are scoped per form. Read our guide to GDPR-compliant forms and take your own advice on what applies to you.
Is a therapy or coaching intake form different?
The admin half is identical: contact details, appointment type, availability, how they found you, fee and cancellation terms. The clinical half is not. A therapy intake form that asks about symptoms, diagnosis, medication or risk is health data almost everywhere, and in the US it is protected health information. Keep those questions in a system built for them and use Upform for booking and general enquiries.
Do patients need an account to fill in the form?
No. You publish the form on a public link or embed it in your website, and people answer straight away with no sign-up and no password. Public submissions run through invisible reCAPTCHA v3, so you get fewer junk enquiries without asking anyone to solve a puzzle. On a phone the form is full-width with a sticky back and next bar.
How much does it cost to run intake forms?
Nothing on the free plan: unlimited forms, unlimited responses, all 21 question types, conditional logic, every integration and 100 MB of file storage. Your forms carry a small Upform mark. Pro is $12 a month and removes the mark, lifts the storage cap and adds up to five team members.
Get started
Take the admin half of intake online tonight
Clone the template, cut it back to the questions your front desk actually uses, publish the link. No card, no response cap, no surprise bill in a busy month.
Upform is not HIPAA compliant and does not sign a BAA. Keep protected health information in a vendor that will.