HIPAA Compliant · SOC 2 Ready

Patient intake forms that work for you

Build fully customizable intake wizards tailored to your practice. Send them securely to patients via email or SMS — and receive completed forms as structured data, ready for your workflow.

SecureINTAKE application screenshot
HIPAA Compliant
256-bit Encryption
Secure Data Storage
99.9% Uptime SLA

Paper intake forms are costing your practice

Illegible handwriting, missing fields, manual data entry, lost paperwork, and compliance risk. SecurePATIENT Intake replaces all of it with a digital workflow that patients can complete before they ever walk through your door.

Custom Intake Wizards

Define the exact questions your specialty requires. Build multi-step wizards with conditional logic — patients only see what's relevant to them.

Email & SMS Delivery

Send intake invitations directly to patients via email or text message. Include a secure link that opens the intake wizard on any device.

Patient Management

Add patients with their contact information, track invitation status, and manage completed intakes from a single dashboard.

Three steps to better intake

From form design to completed submission — the entire workflow is secure, auditable, and effortless.

1. Design your intake form

Use the form builder to create intake wizards customized for your practice. Add demographics, medical history, insurance, consent forms, or anything your specialty needs. Conditional logic ensures patients only answer relevant questions.

  • Drag-and-drop form builder
  • Conditional visibility & required-field rules
  • Reusable templates by specialty
Form builder and wizard editor

2. Invite your patients

Add patients to your roster and send them an intake invitation via email, SMS, or both. Patients receive a secure link to begin their intake wizard on any device — phone, tablet, or desktop.

  • Email and SMS invitations
  • Automatic follow-up reminders
  • Track opened, in-progress, and completed
Patient invitation via email and SMS

3. Receive structured data

When a patient completes the wizard, their responses are submitted as structured JSON — encrypted, validated, and delivered directly to your dashboard. No more deciphering handwriting or chasing missing fields.

  • Structured JSON submissions
  • End-to-end encryption
  • Full audit trail for compliance
Completed intake data view

Built for every specialty

Because you define the questions, SecurePATIENT Intake adapts to any medical practice — from general family medicine to highly specialized fields.

Family Medicine Pediatrics Orthopedics Dermatology Cardiology OB/GYN Psychiatry Ophthalmology Dentistry Chiropractic Physical Therapy Oncology Neurology Urgent Care ENT Urology Allergy & Immunology Pain Management Podiatry Behavioral Health
98%
Patient completion rate
12 min
Average time saved per patient
0
Paper forms required
100%
HIPAA-compliant data handling

Trusted by healthcare professionals

See what practices are saying about SecurePATIENT Intake.

We cut our front-desk check-in time in half. Patients complete their forms before arriving and our staff can actually focus on care.
DR
Placeholder Name
Family Medicine, Example Practice
The customizable forms are exactly what we needed. Our dermatology-specific intake captures information no off-the-shelf form could.
SM
Placeholder Name
Dermatology, Example Clinic
HIPAA compliance was our biggest concern. SecurePATIENT Intake handles it properly — encrypted at rest, encrypted in transit, full audit trail.
JL
Placeholder Name
Practice Administrator, Example Health

Ready to modernize your patient intake?

Start your free trial today. No credit card required. Set up your first intake form in under 10 minutes.

SecurePATIENT Intake

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