Patient Intake Form Template
Patient intake forms need to collect clinical history, insurance information, and consent before the first appointment. This template covers all three in a HIPAA-appropriate structure and syncs to Google Sheets for your admin team.
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What's included in this template
13 fields — customize any field or add new ones with AI.
Need different fields?
Tell the AI what to change — "add a budget dropdown" or "remove phone number" — and it edits the form instantly. Every field type above can be added, removed, or relabeled through the chat interface.
How to use this template
Open the template
Click "Use this template free." Flexform loads the form instantly — no account needed to preview.
Customize with AI
Type what you want to change in the chat: fields to add or remove, rename labels, change field types, or rearrange pages.
Connect & publish
Link to Google Sheets or Slack with one click, then embed on your site or share the link.
Workflow integrations
Connect this form to your existing tools with no middleware. Every submission triggers your workflow automatically.
Real-time sync
Data appears in your CRM or spreadsheet within 1–2 seconds of submission — no cron jobs, no delays.
Conditional routing
Route submissions to different Slack channels, HubSpot pipelines, or Airtable bases based on field values.
Two-way data flow
Pre-fill form fields with CRM data for returning visitors. Update existing records instead of creating duplicates.
Frequently asked questions
Is FlexForm HIPAA compliant for patient data?
FlexForm supports healthcare intake workflows. For HIPAA BAA requirements, contact our team to discuss enterprise compliance options.
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Use this patient intake form template free
Open the template, customize with AI, connect your tools, and publish — in under 5 minutes.
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