Dental New Patient Form Template
A dental practice uses this form to collect new patients’ contact details, visit reasons, health and dental history, medications, allergies, and insurance card.
When to use it
- Before a patient’s first appointment
- When a new patient books online
- To gather health details before a consultation
- When updating a patient’s intake information
What it asks
- Full name
- Email address
- Phone number
- What brings you in today?
- When was your last dental visit?
- Do you have any dental concerns you'd like us to know about?
- Do you have any medical conditions?
- What medications do you currently take?
- Do you have any allergies?
- Upload your dental insurance card
Why it should be encrypted
Medical details, contact information, and insurance cards are private. Encryption helps keep answers unreadable to SealForm and others who should not have access.
Tips
- Tell patients how to contact the practice if they need help completing the form.
- Ask patients to upload a clear image of the front and back of their insurance card if needed.
- Customize the health questions to match the details your team needs before the visit.