Customize the Patient Intake Form Template

Our form templates let you create any kind of WordPress form in a few clicks.

You can select any template to view the demo and try it out. If it works for you, you can import it and publish it in minutes. Each WPForms template is fully customizable too. Our drag and drop form builder makes it easy to adapt any template to fits your business’ needs. When you use our form templates, you can easily:

Import Any Template With 1 Click

Ready to get started? Import any form template and start customizing it right away.
Add or Remove Fields

Use our simple drag and drop form builder to add fields, delete them, or move them around.
Customize Notification Settings

It’s easy to edit the notification emails on any template with your own text or smart tags.
Change the Confirmation Message

Easily display a custom message after submission – or forward your visitor to another page.
Change the Field Labels

Click on a field and change the text to collect the exact information you need.
Change the Notification Email

Add CCed recipients and multiple notifications so you never miss an entry.
Customize the Submit Button

Adapt the words on the button and change the color so that it matches your theme.
Publish Your Form With Ease

Hit publish — that's it! WPForms makes it easy to get your forms online without writing code.

WPForms makes it easy to publish forms on any post or page. You can also publish your forms in the WordPress sidebar or footer. And because we integrate with page builders, you can easily use a template to make an Elementor contact form, or publish any form on a landing page in SeedProd.

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Patient Intake Form Template

PATIENT DETAILS

EMERGENCY CONTACT INFORMATION

INSURANCE PROVIDER

FINAL STEPS

What’s in Our Patient Intake Form?

Our form templates let you create any kind of WordPress form in a few clicks.

Import Any Template With 1 Click

Add or Remove Fields

Customize Notification Settings

Change the Confirmation Message

Change the Field Labels

Change the Notification Email

Customize the Submit Button

Publish Your Form With Ease

PATIENT DETAILS

EMERGENCY CONTACT INFORMATION

INSURANCE PROVIDER

FINAL STEPS

What’s in Our Patient Intake Form?

Looking for something else?

Our form templates let you create any kind of WordPress form in a few clicks.

Import Any Template With 1 Click

Add or Remove Fields

Customize Notification Settings

Change the Confirmation Message

Change the Field Labels

Change the Notification Email

Customize the Submit Button

Publish Your Form With Ease