HIPAA-friendly
patient intake forms.
Replace paper clipboards with secure digital intake. Patients complete forms before they arrive. E-signatures, document uploads, and clinical data — organized and ready before the appointment.
The old way vs the ZiggyIntake way
- Paper clipboards in the waiting room
- Staff manually entering data into systems
- Chasing patients for missing signatures
- Insurance cards copied at front desk
- Forms filed in folders (or lost entirely)
- New patients arrive late because of intake
- Digital link sent via SMS or email before appointment
- Patient data auto-populates in ZiggyHQ CRM
- Consent signed digitally in the form
- Insurance card uploaded from patient's phone
- All records organized, searchable, secure
- Patients arrive ready — staff ready too
Common intake problems. Solved.
Patients filling out paper forms in the waiting room
Send a digital intake link before the appointment. Patients complete it on their phone, at home, in advance — your staff reviews before they walk in.
Chasing signatures on consent forms
Include consent forms and HIPAA acknowledgments directly in your intake form. Patients sign electronically before they arrive.
Manual re-entry of patient data
Every intake submission flows directly into your ZiggyHQ CRM as a structured record — no re-typing, no lost forms, no manual data entry.
Missing insurance cards and referral documents
Patients upload insurance cards, referral letters, or prior authorization docs right in the intake form before their appointment.
Features for healthcare providers
E-signature for consent & HIPAA
Add legally-binding signature fields for consent forms, HIPAA acknowledgments, and treatment authorizations. Signed documents are stored with the patient record.
Document & insurance uploads
Patients upload insurance cards, referral letters, prior auth documents, and medical records directly in the intake form — before the visit.
Smart conditional intake flows
Show relevant symptom questions based on reason for visit. Different intake forms for new vs. returning patients. Collect the right clinical information every time.
Auto-CRM patient records
Every intake auto-creates a structured patient record in ZiggyHQ — searchable, sortable, and ready for your team to act on before the appointment.
Branded patient experience
Your practice's logo, colors, and a custom domain. Patients see your brand, not a third-party form tool — building trust from the first touchpoint.
Completion analytics
Track how many patients complete intake before their appointment vs. at check-in. Identify which questions cause drop-off and optimize your form.
Works for every specialty
New patient intake, medical history, medications, consent, insurance upload.
Injury intake, functional assessment questions, prior treatment history, e-sign consent.
Intake questionnaire, symptom scales, release of information, HIPAA acknowledgment signature.
Pain location/severity intake, health history, auto accident details, consent forms.
Medical history, current medications, dental anxiety screening, insurance upload, e-sign consent.
Chief complaint, symptom onset, insurance card upload, consent to treat — before they walk in.
“We switched from paper intake at our physio practice and the difference is night and day. Patients arrive with forms already complete. Signatures are done. Insurance is uploaded. Our front desk now has time to actually welcome people instead of doing data entry.”
Modernize your patient intake today.
Digital intake forms that patients complete before they arrive. Secure, signed, and auto-organized. $19/mo.
Get Started Free — $19/moNo credit card required.