---
title: Patient intake form
description: A free patient intake form. Send it before a visit, the person fills it in on a phone, and you keep each signed copy with its certificate.
---

# Patient intake form

The details and agreement a new client gives before a first appointment: contact, background, goals, emergency contact and how their data is used.

Use it when a new patient or client books a first visit. It gathers contact details and the background you need.

## Who signs

- Client

## Before you send

- Ask only for what you will use.
- Keep it in the system you are allowed to keep health data in.
- Add your own consent line.

## The facts

- 3 pages
- 27 fields
- About 11 minutes to fill in