Templates/Customer intake

GDPR-conscious intake for solo practitioners.
GDPR-conscious intake for solo practitioners.

Collect medical history, insurance, emergency contacts, and consent in one GDPR-compliant flow. EU-hosted (Frankfurt) with TLS in transit and encryption at rest. Conditional logic skips irrelevant sections. PDFs of each submission email automatically to the patient. Pair with your local compliance setup as needed.

No card required. EU-hosted.

Fields included

  • Full name
  • Date of birth
  • Email
  • Phone
  • Emergency contact
  • Insurance details
  • Medical history
  • Current medications
  • Reason for visit
  • GDPR consent

All fields are customizable. Describe changes in plain English and the AI updates the form instantly.

Ready to use this template?

Open the builder, describe any changes in chat, and publish. Responses route to Slack, Notion, or Sheets automatically.

Related templates

Need something different? Describe any form in plain English.

Build a custom form with AI