Dental Intake Form
Use this secure dental intake form to collect important information from new patients before their first appointment. With Hushmail’s secure forms, patient information is encrypted from the moment it’s submitted, so you can stay compliant and build trust from the start. Send it by email or include it in a welcome packet on your website.
Form Template Preview
Submit this form to see what a completed submission looks like inside Hushmail:
Quick facts about this form
Who it's for:
- Dentists
- Orthodontists
- Dental practices
- Dental office managers
Why use it:
- Collect key patient information before their first visit to make check-in more efficient
- Protect patient privacy with HIPAA-compliant automatic encryption
- Save time and reduce compliance risk by replacing paper forms with a secure digital process
- Make a good impression with a seamless experience right from the start
Where to use it:
- In a welcome email after scheduling a new patient
- In a “New Patients” section on your website
- In appointment confirmation or reminder emails
If your client skips a required field, the form will prompt them to fill it out. No more chasing after clients to fill out missing info.
Your client’s submission will live in Hushmail, where you can keep all submissions secure and organized in folders.
You can also download a PDF of the submission if you want to file a separate copy elsewhere, like your EHR.
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1.
You give us the form(s) you’re currently using in your practice.
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You get a dedicated Customer Care rep to oversee the service and answer questions.
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3.
You end up with custom secure web forms that are easy for your clients to fill out.
