Patient Intake Form Creation

I’m setting up a new intake workflow for my medical practice and need a professionally designed patient intake form delivered in two versions: an online form patients can fill out before their visit and a matching printable PDF for those who prefer paper.

The form only needs to gather patient personal details (name, date of birth, contact information, emergency contact, etc.) and a concise medical history section covering current medications, allergies, past conditions, and surgical history. We are not collecting insurance information at this stage, so you can leave that section out.

I don’t require the digital version to integrate with any practice-management software right now; a standalone, shareable link (Google Forms, Typeform, Jotform, or a similar HIPAA-friendly platform) is fine as long as it’s easy for our staff to download responses as a PDF or spreadsheet.

Deliverables:
• Branded online form link ready to publish
• Fill-able, print-ready PDF mirroring the online form’s layout
• Source files (editable) so we can make future tweaks

Please keep the design clean, accessible, and patient-friendly, following standard medical confidentiality best practices.