Your patient intake form is the first clinical impression your practice makes and the primary data-gathering tool before a first consultation. A poorly designed intake form results in incomplete histories, redundant questioning during visits, and missed clinical information — all of which waste consultation time and reduce the quality of your initial assessment. A well-designed intake form makes your first consultation more efficient, more thorough, and more clinically productive.
For a hormone optimization telehealth practice, the intake form should capture demographic information (name, DOB, state, contact information), chief complaint and primary reason for seeking hormone evaluation, current symptoms (using a validated symptom questionnaire — the Androgen Deficiency in Aging Males (ADAM) questionnaire for men, or the Menopause Rating Scale or Greene Climacteric Scale for women), current medications and supplements, prior hormone therapy history (what was tried, at what doses, and what the outcome was), relevant medical history (diabetes, cardiovascular disease, cancer history — particularly hormone-sensitive cancers, thyroid disease, adrenal conditions), surgical history (oophorectomy, hysterectomy, orchiectomy, prostatectomy — all directly impact hormone status), family history of hormone-sensitive cancers, and current lab results if the patient has recent bloodwork.
The intake form should be delivered digitally, signed electronically, and automatically imported into your EHR — not filled out on paper and scanned. Most EHR platforms support custom digital intake forms that populate directly into the patient chart. This eliminates data entry time and ensures the information is in the right place before you open the chart.
Include a section specifically asking what the patient’s goals are — not just what is wrong, but what they want to feel like, what they want to be able to do, and what has not been addressed by previous providers. This information directly informs your treatment plan and your therapeutic relationship from day one. Session B covers patient systems and workflows. Call 844-734-2112.