Chiropractic + Naturopathic Doctor

3 essential elements of a well-composed intake form

By Dawn Armstrong   

Features Business Management annex chiropractic chiropractor clinic office management interdisciplinary patient care patient intake form professional advice record keeping

What are the essential elements of a well-composed intake form?

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The intake form you use with all of your new patients is more than just the first piece of paper that your patient touches. It gives you an opportunity to make a great first impression for both your profession and your professionalism. The intake form becomes the foundation of their clinical record, and by extension, the care you deliver.

While the space for administrative details (patient ID, contact information, office and privacy policies) are required legally, their presence sets a tone of respect for the patient’s right to full disclosure.

The new patient intake form could be characterized as one of the history twins, because as well as the information you gather about their history during the patient interview, the new patient form will facilitate documentation of subjective facts about the patient’s health history (i.e. their chief complaint, past problems, family issues, current care and lifestyle habits) in their own words.


You are asking your new patient to document a lot of information.There are no hard and fast rules on how many pages long it should be, but the new patient intake forms must be comprehensive enough to let you identify red flags. If there are any reasons why you need to proceed with caution in a particular case, an effective intake form should bring them to your attention.

Essentially, your intake form should have the following three features:

The form should be well constructed with a professional appearance – the font and type size are easy on the eyes and the layout is spacious. As our population ages, more and more people appreciate the readability of documents.

The best new patient intake forms make use of different modalities (explain with words, check off boxes on a list, make drawings on a diagram). Using a variety of methods to collect information from your patient increases the chances of gathering enough of the vital details you will need to make good decisions.

All of the questions should be relevant and clear. Give some thought as to why you are asking any particular question and double-check that the way they are presented will minimize ambiguity.

A well-designed form strikes a balance between respect for your patient’s time (very few new patients are eager to fill out a form that is eight or 10 pages long) and an appreciation of the patient’s need to fully express their situation.

You can include features on the intake form that will serve to educate both the patient and you.  

A customized header – advertising who you are, what you do, how well-educated you are and lists any special skills or interests you have – is more effective than one which just gives your clinic address and contact numbers.

On the checklist of conditions, along with the red flag ones, you can include disorders that you want the patient to know you treat. These would be the same conditions that you would like to see more of – plantar fasciitis, constipation or depression are all conditions that can benefit from our care, but most new patients do not know this. The new patient form is a great tool for informing the public about our scope of practice.

When you include a space for them to indicate who referred them, you can discover potential networking connections for inter-professional collaboration. With the appropriate question you ca also learn how they found you, which will reveal the advertising platforms that are most effective for promoting your practice.

“Should you take on this patient’s case?”
Your intake form should provide an answer to this question. It is critical that you gather enough information at the first visit to be confident that you will not cause harm. The form should give you some insight into the nature of their situation and help you to decide if you are optimistic that you can help them. If the information provided by a new patient raises any suspicion of contraindications to care, you can take appropriate action to ensure their safety, even if this means declining to take on their case.

A well-designed new patient intake form will improve your consistency and efficiency in spotting both red flags and opportunities for building your practice. Your new patients will each have their own specific needs, but what they need most is to know you “get” them, so give them a form that facilitates this.

DR. DAWN ARMSTRONG is a graduate of CMCC and has been in practice for over 30 years. She is currently focused on promoting life-long learning and professional development and has created a continuing education course – Clinical Record Keeping: A Hands-On Approach. Learn more at

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