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Dental New Patient Intake Form

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An inefficient intake process may be keeping your patients coming back to your office again and again, or even worse, not wanting to step foot there again. A pre-appointment dental new patient intake form can help reduce stress and increase patient satisfaction by offering an easy way to provide all the information you need prior to meeting you. This will also allow more time during the actual appointment so you can provide a better service.

Read on to find out what vital aspects your patient intake form should cover so you can create an effective document and avoid set-backs.

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Essential Elements to Cover in Your New Patient Forms

Covering the following aspects on your client intake forms will help you deliver quality services, tailored to your patient's needs and anticipate any inconveniences. Ask your new patient to take the time and fill out this form prior to their visit. Here's what you must cover.

Basic Client Information

To begin your patient intake form, make sure to gather all the basic personal information. Include their full name, age, gender, phone number, billing/physical address and email as well as emergency contact information including the relationship with the patient. If your new patient is underage, make sure to request the same information from the person responsible for the patient.

Medical and Dental History

Having up-to-date knowledge on your patient's medical and dental history will be beneficial as you move forward with your treatment plans because you'll be aware of medical problems and prescriptions that can affect therapy progress or recovery. Here are some aspects you'll want to cover in this section.

- Last dental visit and name of previous dentist

- Current dental problems or concerns (pain, swelling, etc...)

- Whether the patient is currently under care of any physician.

- Previous serious illnesses, hospitalizations, or extensive medical care.

- Recent medical examinations.

- The use of prescription and non-prescription drugs.

- Allergic conditions and reactions.

Insurance Details

Verifying insurance is crucial when it comes to dental care. This will help you identify deductibles applying to a new patient's first appointment and determine their eligibility for further dental procedures or emergency appointments. Here's what you should know.

- Primary insurance company

- Policy/Plan details

- Subscriber ID or S.I.N. #

- Type of coverage

- Preventive services coverage

- Plan restrictions or limitations

- Any secondary insurance

Stay HIPAA Compliant

HIPAA regulations apply to all forms of communications including intake and consent forms. Your new patient forms can include a Notice of Privacy Practices which new patients must sign in acknowledgment. This notice serves to provide patients with a user-friendly explanation of their individual rights regarding their personal health information as well as the privacy practices of health plans.

Create Perfect Intake Forms With Bonsai

Save time and create a professional intake form using a lightweight form builder. You can easily print it or share the document with your clients via email, or URL, so they can complete forms online from any device.

You can also have the questionnaire embedded on your website to boost client intake. With fully customizable fields you can add as many questions as you need and incorporate branding elements to make your patient forms unique and easily recognizable.

Start your 14-day free trial today to check out these and many more benefits Bonsai has to offer!

Dental New Patient Intake Form

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