Great care starts with better intake — and smarter documentation.

At S10.ai, we believe patient intake shouldn’t be a time-consuming task. It should be the first step toward delivering seamless, personalized care.

A well-designed intake process gives you the essential details upfront — from medical background to insurance — so your team can focus on what really matters: building trust with your patients.

But let’s face it: medical documentation often slows things down. That’s why we created an easy-to-use, fully customizable patient intake form — to help you gather the right info with zero friction.

Let’s simplify onboarding.

Below, we break down what’s inside the form and how it helps create a smoother, faster intake workflow.

🆓 Download Your Free Patient Intake Form

Click here to get a printable, fillable PDF intake template — ready to use or adapt for your practice.

Why Use S10.ai’s Intake Form Template?

Editable & Printable: Tailor it to your clinic’s exact needs.
Time-Saving: Designed for speed and efficiency.
HIPAA-Compliant: Built with privacy and compliance in mind.

What’s Inside the Patient Intake Template

We’ve structured each section to capture what matters — no fluff, no redundancy.

Patient Information
Full name, DOB, contact info, emergency contact — all the basics for accurate identification.
Insurance & Billing
Details that ensure smoother claims processing and payment coordination.
Medical History
Medications, past procedures, chronic conditions, family health history, and allergies.
Current Health Concerns
Understand why the patient is here and what they’re experiencing now.
Lifestyle & Social History
Smoking, alcohol, exercise habits, work environment — key context for care decisions.
Consent & Privacy Acknowledgment
Informed consent and HIPAA acknowledgment — all in one place.

Go Beyond Forms: AI-Powered Intake with S10.ai

Forms are great. But what if the intake process handled itself?

With S10.ai’s AI scribe, your practice can automatically capture patient information in real time — no typing, no delays.

Here’s how our AI intake assistant helps:

Auto-fill data: Medical history, demographics, and insurance — done for you.
EHR integration: Syncs directly with your existing systems.
Customizable fields: Adjust the form to suit your practice’s workflow.
Cross-platform support: Use on desktop, tablet, or mobile — in clinic or remotely.
HIPAA-grade security: Keeps patient data secure at every touchpoint.

During new patient onboarding, S10.ai’s AI highlights key details like allergies, medications, and conditions — while filtering out the noise. You get cleaner, faster, and more complete records — without lifting a finger.

📥 Ready to Try It?

Download your free intake form now

Then discover how S10.ai can take the busywork out of onboarding — so you can get back to care.

New Patient Intake Form Free Template

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NJ, Princeton - Carnegie Center,
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