Intake Form help

Links, cover letters, brochure information, articles and other items which can be put to use in practice and when approaching others in the health care fields.

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Intake Form help

Postby swingingdelirium on Sun Nov 14, 2010 12:20 pm

I have seen many intake form samples, and even some free ones to use, but I would really like to make my own intake forms, or download a template and go from there. Has anybody else done this or know of any computer programs that could help me with this? I just don't like the forms that are so detailed the questions seem probing, such as "How many children do you have; How old are they? Are you concerned about your stretch marks?" "Do you have a history of mental illness? Do you have family members with mental illness?" "Do eat a lot of melons? Do you smell or tap them to decide if they are ripe?" (Okay, that last one was a joke, but you get the idea). I have even seen forms for MT's that ask questions completely out of legal scope-of-practice, which also needs to be avoided.
What do you do for your intakes?
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Re: Intake Form help

Postby Blue on Sun Nov 14, 2010 5:42 pm

I made my own. I didn't have a template or anything, just asked the relevant questions and left spaces for the answers.
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Re: Intake Form help

Postby moogie on Sun Nov 14, 2010 6:15 pm

What I did was download a few templates and then edit one to my liking.

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Re: Intake Form help

Postby Taoist on Sun Nov 14, 2010 7:31 pm

Blue wrote:I made my own. I didn't have a template or anything, just asked the relevant questions and left spaces for the answers.


This is what I did as well. As long as you have basic computer knowledge it's pretty easy. I have OpenOffice (free word processing/spreadsheet/power point program) on my computer that I used. You can also use Microsoft Word or really any word processor program.
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Re: Intake Form help

Postby Pete on Sun Nov 14, 2010 9:08 pm

For relaxation clients, I just use the free one that ABMP has on their website. For medical massage patients, I have a specific intake packet which I made for myself (6 pages long) that I have them complete.
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Re: Intake Form help

Postby pueppi on Mon Nov 15, 2010 10:24 am

I made my own. I am happy to mail you a copy to you if you like.

Mine is fairly simple, I use it for medical and relaxation massage clients alike.

I always do a detailed intake with my clients, writing all of the additional info I need on the back of the initial intake page they filled out before walking into the room. For me, this ensures I have any extra info all on that one page.

Anything to follow, such as SOAP's, etc, goes in their chart.

Note: I do have Massage Office Software, so I will add anything I want reitterated (from the detailed questioning) into the initial SOAP note on the computer.


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Re: Intake Form help

Postby AngelaJudy on Tue Nov 16, 2010 3:33 pm

This is everything that is on the one I made on OpenOffice Writer(the opensource equivalent of MS Word). Of course it looks better on there than on here. Very simple and to the point. I also write any additional notes on the back.


A Nurturing Touch Massage & Bodywork

Client Information

Name: ______________________________ Home Phone:_______________________ Cell Phone: _______________________

Address: ____________________________________________ City, State, Zip: _______________________________________

E-mail: _______________________________ Occupation: ____________________________ Birth Date: __________________

How did you hear about us? (friend, google, craigslist, etc.) ________________________________________________________

If referred, by whom?_______________________________________________________________________________________

Health Information

What brought you in today? (to relax, back pain, etc.) _____________________________________________________________

Have you ever received a professional massage/bodywork? Yes No If yes, how recent? _______________________________

Are you in good health? Yes No Is your blood pressure normal? Yes No

Have you had, or do you have any medical condition, serious or chronic illness, surgery, infection, or skin condition? Yes No Please describe: ___________________________________________________________________________________________
________________________________________________________________________________________________________

Have you had any broken bones, arthritis, joint problems, spinal disc problems, or traumatic accidents?
Yes No Please describe: _________________________________________________________________________________
________________________________________________________________________________________________________

Are you currently under a doctor's, chiropractor's, or other health practitioner's care? Yes No
If yes, for what conditions(s)?________________________________________________________________________________
Please list any medications: __________________________________________________________________________________

Do have allergies or sensitivities?______________________________________________________________________________

Any medical condition or concern not otherwise listed?____________________________________________________________

If female, are you pregnant? Yes No If pregnant, what is your due date? _____________________

In case of an emergency, notify: ________________________________________Phone: ___________________________

Policies

Cancellation Policy: Kindly give 24 hours notice to change or cancel your appointment to avoid any cancellation fee.
Lateness Policy: You are responsible for full payment for the time as scheduled. If you arrive late, your time may be shortened at your practitioner's discretion, so that the next client may start on time.
Disclaimer/Release: I understand that therapeutic massage/bodywork is a health aid and does not take the place of a doctor's care. If I experience pain or discomfort during the session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort. Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree that my practitioner, A Nurturing Touch Massage & Bodywork, and its staff shall not be liable should any injury occur, due to my withholding information, or for any other reason. I agree to keep my current and future practitioners updated as to any changes in my medical profile, and I understand that there shall be no liability on the practitioners' part should I fail to do so. Information exchanged during any therapeutic session is educational in nature and is intended to help me become more familiar and conscious of my own health. It is to be used at my own discretion and is not to be construed as medical advice. I acknowledge that this a professional environment and the practitioner has the right to terminate the session at any time for any inappropriate behavior and payment will be due for the full session.

Signature: ____________________________________________________ Date:______________________________________
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Re: Intake Form help

Postby AngelaJudy on Tue Nov 16, 2010 3:35 pm

Yeah the format obviously doesn't look right on here, but if you copy and paste it, you can tweak it.
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Re: Intake Form help

Postby Blue on Tue Nov 16, 2010 11:43 pm

AngelaJudy wrote:Yeah the format obviously doesn't look right on here, but if you copy and paste it, you can tweak it.


This is off topic....but do you know how to make address/shipping labels work using open office?
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Re: Intake Form help

Postby moogie on Wed Nov 17, 2010 10:49 am

Blue wrote:This is off topic....but do you know how to make address/shipping labels work using open office?


I use Avery labels and you can go to their website and use their free templates. If someone can't help you out regarding open office, then perhaps you can try the website of the label's maker.

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Re: Intake Form help

Postby Blue on Wed Nov 17, 2010 3:19 pm

Thank you, Moogie. I had tried the avery template but it has to be downloaded, and I only have open office to download it to, and that opens it as read only. So I get a blank page and can't write a single character on it! Argh. My computer recently died and had to be replaced, but I couldn't afford to add MS office. I figured any word processor would do, but now I am not so sure of that!! :confused:
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Re: Intake Form help

Postby pear2apple on Sun Mar 27, 2011 2:36 pm

pueppi wrote:Note: I do have Massage Office Software, so I will add anything I want reitterated (from the detailed questioning) into the initial SOAP note on the computer.


What is Massage Office Software?

Also, does anyone have all their Intake Forms/etc completely paperless? Do you scan your Intake Forms into a client file on your computer too?
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Re: Intake Form help

Postby Bert on Tue Mar 27, 2012 9:46 pm

THANK YOU! This has all been super helpful.
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Re: Intake Form help

Postby athletica on Wed Mar 28, 2012 10:26 am

I have two patient forms. One you can download from our website, It is lengthy! My thought is those willing to fill it out in advance of the appointment are probably looking to provide the additional details. Our intake form that patients fill out at the clinic is 1 page and asks the basic questions (personal info, meds, referral type, etc).
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Re: Intake Form help

Postby pueppi on Thu Apr 05, 2012 6:12 am

pear2apple wrote:
pueppi wrote:Note: I do have Massage Office Software, so I will add anything I want reitterated (from the detailed questioning) into the initial SOAP note on the computer.


What is Massage Office Software?


Link: http://www.islandsoftwareco.com/ecommerce/catalog/


Also, does anyone have all their Intake Forms/etc completely paperless? Do you scan your Intake Forms into a client file on your computer too?



I do not do paperless. I keep a folder for each client and print out their info from my software (where it stays as a backup).
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Re: Intake Form help

Postby athletica on Thu Apr 05, 2012 12:48 pm

pear2apple wrote:
pueppi wrote:Note: I do have Massage Office Software, so I will add anything I want reitterated (from the detailed questioning) into the initial SOAP note on the computer.


What is Massage Office Software?

Also, does anyone have all their Intake Forms/etc completely paperless? Do you scan your Intake Forms into a client file on your computer too?



We attempted to move to completely paperless clinic. We found many patients did not like doing intake forms on the ipad. We now have patients fill out the paper form. We then scan the form to the computer.
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Re: Intake Form help

Postby EclecticK on Wed Aug 08, 2012 5:22 pm

athletica wrote:We attempted to move to completely paperless clinic. We found many patients did not like doing intake forms on the ipad. We now have patients fill out the paper form. We then scan the form to the computer.


That's very interesting. I'm part of a small software company that makes SOAP Notes for iPad -- we've gotten a few requests to do a client intake app as well, so I'm definitely curious about the resistance from patients. Did anyone give comments on why they didn't like it? Typing on the iPad a pain?

shameless plug below while I'm here :) It's a relatively new app, and we're always open to ideas and feedback!

http://www.eclectic-dna.com/soap-notes/
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Re: Intake Form help

Postby pueppi on Tue Aug 21, 2012 9:26 pm

EclecticK wrote:
athletica wrote:We attempted to move to completely paperless clinic. We found many patients did not like doing intake forms on the ipad. We now have patients fill out the paper form. We then scan the form to the computer.


That's very interesting. I'm part of a small software company that makes SOAP Notes for iPad -- we've gotten a few requests to do a client intake app as well, so I'm definitely curious about the resistance from patients. Did anyone give comments on why they didn't like it? Typing on the iPad a pain?

shameless plug below while I'm here :) It's a relatively new app, and we're always open to ideas and feedback!

http://www.eclectic-dna.com/soap-notes/



As someone who is fairly non-technical... I have a colleague who requests that his clients fill out their intake on an iPad. I asked to see and try it. To be honest, it' sjust easier for me to write with a pen.

He said he has some people who like it and those who don't, he fills it out for them.

It's just not my cup of tea.
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Re: Intake Form help

Postby mikewurtz on Sat Nov 10, 2012 9:17 pm

I'm looking to go completely paperless but I'm having trouble finding a decent app / program to use. Do you know the name of the iPad app your friend is using?
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Re: Intake Form help

Postby pueppi on Tue Nov 13, 2012 7:16 am

pueppi wrote:As someone who is fairly non-technical... I have a colleague who requests that his clients fill out their intake on an iPad. I asked to see and try it. To be honest, it's just easier for me to write with a pen.

He said he has some people who like it and those who don't, he fills it out for them.

It's just not my cup of tea.


mikewurtz wrote:I'm looking to go completely paperless but I'm having trouble finding a decent app / program to use. Do you know the name of the iPad app your friend is using?


He wasn't using an app. He just created a document in Word, loaded it into his ipad and has the client fill it out. He said it was very easy.

I guess from there he loads it into whatever he keeps his "paperless" charts in.


BTW, welcome to BWOL! I did locate three links that may be useful for you. However, since I am pretty un-technical, I would ask that in return, you take time to come back and post anything you find that could also be useful for others. And, when you locate something you like, that you report a little about it, for the entire community. We can only grow stronger if everyone participates.

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