Client intakeClinics & physiotherapy

New patient registration form

Many practice registration forms still ask for pages of history that nobody reads before the first appointment. This template keeps to what reception and the doctor actually need: who the patient is, how to reach them, how their visits are covered and why they're coming. One optional question leaves room for medication or allergies, and a consent checkbox records that the patient agrees to you storing their details.

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Opens as an editable form in your dashboard. If you're not signed in yet, you'll sign in or create an account first.

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Try the fields: this preview doesn't send or store anything. The form you create works the same way and emails each submission to you.

What's in this template

Every field can be renamed, reordered, made optional or removed in the form builder.

  • Full nameShort answer · Required
  • Date of birthDate · Required
  • Phone numberPhone · Required
  • EmailEmail · Required
  • How will your visits be covered?Single choice · Required
  • Reason for your visitLong answer · Required
  • Anything the doctor should know before your first visit? (optional)Long answer · Optional
  • ConsentCheckbox · Required

How to use this template

  1. Open it in your dashboardSelect “Use this template”. If you don't have an account yet, sign up first; the form opens right after.

  2. Make it yoursChange the questions, options, colours and the thank-you message in the form builder, then save.

  3. Share it and get submissionsShare the form's link or link to it from your website. Each submission is emailed to you and saved in your dashboard.

Tips for this form

  • Ask only what your practice needs before the first visit; a detailed history is usually better taken in person.
  • Rename the insurance options to the insurers and schemes you work with, or remove the question if it doesn't apply.
  • Link the form in your appointment confirmation so new patients can fill it in on their phone before they arrive.
  • Add a short paragraph above the consent checkbox with a link to your privacy notice.

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Questions about this template

Why doesn't the form ask for a full medical history?

Most practices take the detailed history during the first appointment. Asking less up front keeps the form quick to complete and limits the health information you store. If you need more, add the specific questions in the builder.

Can I change the insurance question for my country?

Yes. The options are a starting point: in the builder you can rename them, add your own or turn the question into a dropdown.

Where are the registrations stored?

Each registration is emailed to your account address and saved under Submissions in your dashboard, where you can also export them as a CSV file.

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Start with this form, change anything later

The template opens in the form builder, where you can edit every question and choose who receives the submissions.