Free templates for your business

General intake form

A simple form to get to know clients before their first appointment, suitable for any service.

What’s on the form

• Health historyCurrent or past conditions · Surgeries and hospital stays · Allergies (medications, foods, products) · Current medications · Are you pregnant or breastfeeding?
• Lifestyle habitsPhysical activity · Diet · Sleep · Smoking and alcohol use

Also includes personal details, reason for the appointment, a declaration, and signature.

Aesthetic treatment intake form

For beauty studios and aesthetic clinics: treatment history, contraindications, and expected results.

What’s on the form

• Aesthetic treatment historyPrevious aesthetic treatments · Previous adverse reactions · Current skin care products · Sun exposure and sunscreen use · Skin type
• Health and contraindicationsAllergies to cosmetics, anesthetics, or latex · History of keloids or poor wound healing · Recurring cold sores · Autoimmune diseases · Use of anticoagulants or isotretinoin · Are you pregnant or breastfeeding? · Pacemaker or metal implants
• ExpectationsWhat would you like to improve? · What results do you expect?

Also includes personal details, reason for the appointment, a declaration, and signature.

Physical therapy intake form

For physical therapists: pain location and intensity, previous injuries, daily routine, and treatment goals.

What’s on the form

• Complaint and painWhere does it hurt? · Pain intensity, from 0 to 10 · When did it start, and what makes it worse or better? · Does the pain spread to another area?
• HistoryInjuries, fractures, and surgeries · Recent imaging tests · Previous treatments · Chronic conditions (high blood pressure, diabetes, other) · Current medications
• Daily routine and functionPostures and physical demands at work · Physical activity · Limitations in daily life · Treatment goal

Also includes personal details, reason for the appointment, a declaration, and signature.

Nutrition intake form

For nutritionists: goals, medical history, eating habits, and lifestyle.

What’s on the form

• GoalMain goal for the appointment · Current weight and height · Desired weight
• Medical historyRecent illnesses and tests · Current medications and supplements · Food allergies and intolerances · Family history of illness · Bowel habits
• Eating habitsMeals per day and meal times · Favorite foods and foods you avoid · Daily water intake · Alcohol consumption · Who prepares your meals
• LifestylePhysical activity · Sleep · Work routine

Also includes personal details, reason for the appointment, a declaration, and signature.

Psychology intake form

For psychologists: concerns, previous treatment, routine, and support network.

What’s on the form

• Reason for seeking careWhat brought you to seek care? · How long have you been feeling this way? · What do you hope to get from treatment?
• HistoryPrevious psychological or psychiatric treatment · Current medications · Previous hospitalizations · Family history of mental health conditions
• Routine and well-beingSleep · Nutrition · Relationships and support network · Work or studies

Also includes personal details, reason for the appointment, a declaration, and signature.

Dental intake form

For dentists: concerns, dental history, and health conditions that may affect treatment.

What’s on the form

• Chief concernReason for the appointment · Pain or sensitivity: where and for how long
• Dental historyDate of last dental treatment · How many times a day do you brush your teeth and floss? · Bleeding gums · Do you grind or clench your teeth? · Previous orthodontic treatment
• General healthAllergies to anesthetics, latex, or antibiotics · Heart disease, diabetes, or high blood pressure · Blood clotting problems · Use of blood thinners · Are you pregnant or breastfeeding? · Smoking

Also includes personal details, reason for the appointment, a declaration, and signature.

Veterinary intake form

For veterinary practices and services: owner and pet details, health history, and routine.

What’s on the form

• Pet ownerFull name · Phone · Email · Address
• PetName · Species and breed · Sex and whether neutered · Age or date of birth · Weight · Color and distinctive markings
• Reason for the appointmentWhat is the reason for the appointment? · How long has this been happening?
• Health historyAre vaccinations and deworming up to date? · Previous illnesses, surgeries, and hospitalizations · Allergies · Current medications · Female: Has she had any litters, or is she in heat?
• Daily routineFood (type and amount) · Appetite, thirst, stool, and urination · Interaction with other animals · Access to the outdoors

Fitness health history form

For gyms and personal trainers: goals, health history, injuries, and workout routine.

What’s on the form

• GoalsPrimary goal · Desired timeframe for reaching your goal · Current weight and height
• HealthHeart disease, high blood pressure, or diabetes · Chest pain or dizziness during exercise · Surgeries and hospitalizations · Current medications · Are you pregnant or breastfeeding?
• Injuries and limitationsPast or current injuries · Joint or back pain · Movements you avoid
• Workout routineDo you currently exercise? What kind? · Days and times available for workouts · Diet and sleep

Also includes personal details, reason for the appointment, a declaration, and signature.