Mobile Patient Intake Form

Advance your healthcare facility with our new Mobile Patient Intake Form. Now available within our 140 pre-built app catalog. FREE with your subscription to Forms On Fire.

With Forms On Fire, you can manage your on-the-go workforce more effectively by capturing and recording the critical data your business uses. Our system is a searchable, reportable database that is instantly available from the web, smartphones or tablets. Streamline tasks like new patient intake, patient survey, child medical history and more. Our pre-built apps can be quickly changed using our simple drag n’ drop form designer.

Build your own forms or start with one of our pre-built forms. Not just forms but applications that will prove to delight! Manage all your entire medical office starting with our Mobile Patient Intake Form. Available on iOS and Android.

Information gathered in the Mobile Patient Intake Form includes:

• Patient name
• Birth date
• Age
• Sex
• Height
• Weight
• Marital status
• Draw capable picture diagram (male and female)
• Days in pain
• Medication
• Insurance information
• Picture for insurance card
• Picture for driver license
• Doctor name
• Doctor phone number
• Doctor email
• Emergency contact name, relationship and phone number
• Patent signature
• Date of visit

Forms On Fire integrates to over 500 systems out of the box. Store your Mobile Patient Intake Forms in Word, Excel, PDF or all three. Forms On Fire supports email, saving to DropBox, Google Drive, OneDrive and more. Easily organize your data and connect to your electronic medical records system. Supported connectors even include REST!

• Other pre-built mobile form applications include:
• Child medical history form
• Doula intake form
• Health evaluation form
• Healthy haircare goals
• Nursing assessment
• Nursing services inquiry form
• Patient demographic information
• Patient satisfaction survey
• Personal training consultation questionnaire

Forms On Fire is HIPAA compliant and meets the highest standards of security and reliability. Start a free trial of Forms On Fire and instantly install and begin using our Mobile Patient Intake Form.