Put a first-visit intake on a clinic marketing site so reception is not retyping clipboard paper. Collect the answers in a dashboard, then keep clinical records in your EHR—not in a public web form.
Register the clinic domain and copy the ID into this builder.
Leave date of birth and visit reason on; hide insurance if you do not bill it from this page.
Sit the form next to parking and arrival instructions, not on the homepage hero.
Copy rows into the EHR; do not treat the form dashboard as the legal medical record.
An intake form is the administrative front door: who is arriving, how to reach them, why they booked, and a short note on allergies or current medicines. US practices treat it as a HIPAA-covered workflow once health details land in a designated record set; UK practices treat the same fields as NHS or private-clinic personal data under UK GDPR.
This page is for the brochure-site layer—Squarespace, Hugo, or a WordPress HTML block—not a replacement for Epic, EMIS, or SystmOne. Use it to stop PDFs in email and to timestamp who asked for an appointment before a clinician opens the chart.
Ask for enough to prepare the room, not enough to recreate a full medical record on a marketing domain.
Do not request Social Security numbers, National Insurance numbers, or passport scans on a public HTML form. Identity documents belong in a verified portal or at the desk with staff present.
Most clinics still mix paper, patient portals, and a ‘please email the PDF’ line on the contact page.
Put the form under ‘New patients’. Submissions hit a dashboard instead of the practice manager’s personal Gmail.
MyChart, Patient Access, and similar logins are the right place for full history once the person is already on the panel.
Still required for signatures in many US offices; transcription delay is why a web first pass exists.
Useful at multi-site scale. Overkill if you only need contact plus visit reason on a one-page practice site.
Independent US practices and UK private clinics often ship a static site with no PHP. Point the form action at your form backend so Netlify or GitHub Pages can still accept intake without a server you patch.
Route notifications to a shared intake mailbox. US covered entities still need a BAA and minimum-necessary review; UK clinics still need a lawful basis and retention schedule. The HTML does not grant either.
No generator makes a page HIPAA-compliant. US clinics need policies, access control, and often a BAA with vendors that store PHI. Use this form for appointment-prep fields and keep charts in the EHR.
Only if your privacy notice says so and staff know how to handle it. Prefer leaving that field optional or off on a public marketing form.
No. Do not collect passport, driving licence, SSN, or NI scans through a public HTML file field.
Yes. The generated HTML prints cleanly if a US office still wants a paper chart insert after a human reviews the row.
For allied-health, coaching, and private-practice clients who are not hospital inpatients.
Welcome packet fields for first appointments at GP-style and specialist offices.
Structured past history, medications, and allergies before a clinician visit.