Template library · Intake forms
Client Intake template
Please complete before your first appointment.
- 16 fields across 3 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
- DateDate
- PractitionerText
Contact Info
- Full nameText
- Date of birthDate
- Phone numberText
- EmailText
- Home addressText
- Emergency contact (name & phone)Text
Service Details
- Service requestedText
- Reason for your visitText
- How did you hear about us?Choice
Health & Preferences
- Relevant health conditionsText
- AllergiesText
- Preferences or special requestsText
- Client signatureSignature
- Date signed (client)Date
When to use it
Send an intake form when a new client books, so their history, contact details and reasons for coming are in front of you before the first appointment rather than taken down during it.
How it works in MyWellOps
- Choose it from Documents and adjust the questions to your practice.
- Send it to the client, who completes it in their client portal.
- Their answers are kept on the client’s record, ready for the first session.
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