What is a patient intake form?
A patient intake form is the set of questions a practice asks before an appointment: identity and contact details, emergency contact, medical scheme or health fund details, referral information, the presenting problem, relevant history including medications and allergies, and consent to treatment and to how the practice handles the information.
Written by the HeroMed team · Last reviewed 16 September 2026
What goes on it
| Section | What it covers |
|---|---|
| Identity and contact | Name, date of birth, mobile, email, address |
| Emergency contact | Name, relationship, number |
| Funding | Medical scheme or health fund, plan, membership or Medicare / DVA / NDIS details |
| Referral | Referring practitioner and reason, letter attached |
| Presenting problem | What brings them in, when it started, what they have tried |
| History | Conditions, surgery, medications, allergies |
| Consent | Treatment consent, privacy notice, optional consents |
New patient versus follow-up
A new-patient form covers all of the above. A follow-up form should ask three or four questions: have contact or funding details changed, what has changed since the last visit, and any change to medications or allergies. Re-asking a full history produces careless answers.
The test of a good one
Every field has someone who reads it, and the answers land on the patient record without anyone re-typing them. If a form arrives as an email or a PDF that reception copies into the file, it has moved the work rather than removed it.
Fuller guide: digital patient intake forms — what to collect and when. HeroMed attaches the intake form you choose to each booking page, lets you send any intake form for a particular booking, verifies the person completing it by email one-time code, and files the answers onto the patient record.