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Ready-to-use intake forms built for functional medicine practitioners. Pick a category, find your form, customize in minutes.
Popular Templates
Comprehensive Initial Intake
The full new-patient experience. Covers medical history, current symptoms, family history, and lifestyle factors in one form.
View →GI Health Questionnaire
Focused digestive health intake with symptom severity scales and food relationship tracking.
View →Hormone Health Intake
Thyroid, adrenal, and reproductive hormone screening for integrative and functional medicine practices.
View →Chronic Fatigue Assessment
Identify contributing factors including sleep quality, stress load, and mitochondrial function markers.
View →Autoimmune Screening Form
Family history, symptom timeline, and trigger identification for suspected autoimmune cases.
View →Pediatric Intake (0-12)
Developmental milestones, birth history, and parental concern tracking for young patients.
View →Mental Health Intake
Mood, sleep, stress, and cognitive function screening with standardized wellness scales included.
View →Metabolic Syndrome Intake
Blood sugar, blood pressure, and waist circumference tracking for pre-diabetes and metabolic health.
View →Detox Protocol Intake
Environmental exposure history and liver support readiness assessment for detox programs.
View →Cardiovascular Health Form
Lipid history, family heart disease risk, and lifestyle factor evaluation for preventive care.
View →IV Therapy Consent
Informed consent for IV nutrient therapy including risks, benefits, and emergency contact info.
View →HIPAA Acknowledgment
Required patient privacy acknowledgment form meeting federal HIPAA requirements.
View →Follow-Up Progress Note
Re-check symptom changes, treatment adherence, and new concerns between visits.
View →Dietary Analysis Form
Macro and micronutrient intake, food sensitivities, and meal timing patterns.
View →Sleep Quality Assessment
Sleep duration, interruptions, environment factors, and daytime fatigue tracking.
View →Stress & Cortisol Inventory
Perceived stress levels, burnout indicators, and HPA axis symptom checklist.
View →Supplement & Herb History
Current protocols, dosages, and potential interaction risks from patient-reported supplements.
View →Environmental Toxin Exposure
Occupational exposures, household chemicals, water source, and cumulative toxin burden.
View →Pre-Conception Health Form
Pre-fertility screening covering reproductive history, hormonal balance, and nutritional status.
View →Pain & Inflammation Intake
Pain location mapping, severity scales, and inflammatory marker lifestyle correlations.
View →Thyroid Function Screening
Symptom checklist and risk factors for hypothyroidism and Hashimoto's evaluation.
View →DUTCH Test Prep Form
Pre-instructions and hormone therapy history for patients scheduled for DUTCH testing.
View →SIBO Intake Questionnaire
Bloating patterns, food triggers, and migration history for SIBO evaluation.
View →Practitioner Agreement Form
Terms of service, scope of practice acknowledgment, and telehealth consent for new patients.
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