Healthcare
Patient Intake Template
Digitise your patient intake process with a comprehensive form that captures personal details, medical history, current medications, allergies, and insurance information. POPIA-compliant with built-in consent for data processing. Ideal for doctors, dentists, physiotherapists, and other healthcare providers in South Africa.
How the Patient Intake template works
- Customise. Open the template in FlexForms and tweak the fields, your company branding, and the PDF layout to match how you already work.
- Send. Enter the recipient's name and either WhatsApp number or email address. FlexForms delivers a secure link backed by one-time PIN verification.
- Sign. The recipient verifies with a short PIN, completes the form on their phone, and signs with their finger — no app, no account.
- Done. You receive a branded PDF with embedded audit trail (who signed, when, from where) stored against the contact record.
Fields Included
Patient Name
ID Number
Date of Birth
Medical Aid
Medical Aid Number
Allergies
Current Medications
Medical History
Emergency Contact
Consent
Signature
Add, remove, or rearrange any of these fields to fit your workflow. FlexForms supports text, multi-choice, dates, file uploads, signatures, and payment fields.
Use Cases
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Doctor's rooms patient intake
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Dental practice registration
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Physiotherapy intake
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Specialist referral forms