Revamping your Intake Forms?

Hello wonderful Happy Charters!!! :)

Recently we have added our online intake form customization - which we are really excited about.

In light of this, many of you may be thinking... hmmm perhaps the intake form I'm using could do with a revamp.

Especially our Happy Charting community acupuncturists customizing their new online intake forms right now!

So I've asked some of our Happy Charting community - who are incredibly awesome and savvy, to share their current intake forms that they have been using in their community acupuncture clinic.

And they have so graciously done so!

(They are seriously amazing people.)

So in honor of our launch of our online intake form feature at Happy Charting - here are 10 intake forms and consent/privacy policy forms currently used by different community acupuncture clinics.

*in the case where the same privacy/consent forms were used - we omitted them to prevent you from seeing them twice :)

 

BLACK SHEEP COMMUNITY ACUPUNCTURE - Valerie Kurek

Valerie is an insane badass community acupuncturist who just keeps growing and growing and growing. She is one of the hardest working, business savvy women I've had the pleasure of meeting. Not only is she gorgeous but she is the fuel, the spark and the fire that breathed Happy Charting into life. I am so very thankful to her and she holds a very dear place in my heart.

www.blacksheepacupuncture.com

www.blacksheepacupuncture.com

Valerie - Informed Consent.png
Valerie - Intake Form.png

BSCA's Medical Consent Form + Intake Form - short, simple, easy and straight to the point. Love it!

 

THE BOW ACUPUNCTURE & COMMUNITY WELLNESS - Ronnie Yocham

Ronnie has been a champion of Happy Charting from the beginning and as time has continued, he is considered a treasured friend. He has a talented ability to envision innovative future possibilities as well as the passion to see it done. Which is why I always listen to his suggestions. Something that Ronnie has that sets him apart is his huge huge heart.

www.bowacupuncture.com

www.bowacupuncture.com

Ronnie - Intake Form-1 .png
Ronnie - Intake Form-2 .png
Ronnie - Intake Form-3.png

Detailed and different! This is some good variety :) great inclusion of other important notices like HIPAA and privacy practices and information for new patients. Good job Ronnie! :)

 

WHOLE HEALTH ACUPUNCTURE - Michael Koziol

Michael has been one of the earliest and most dedicated supporters/adopters of Happy Charting. What makes him a GREAT community acupuncturist and an even greater healer in his community is his witty and fun personality as well as his caring and compassionate soul. These are just a few personality traits of Michael that explain why his clinic is thriving and why his patients love him so much.

www.wholehealthacupuncturechicago.com

www.wholehealthacupuncturechicago.com

Michael - Online Intake Form.png
Michael - Online Intake Form 1.png

Very easy. Very simple. Lots of checkboxes which allows each new patient to fill out the form super quickly! A great, no hassle intake form.

 

UNITY COMMUNITY ACUPUNCTURE - Brandee Goedecke-Shilling

Brandee is an absolute visionary. Her and her husband Andre have been amazing supporters since the first moment I met them. Aside from her awesome bread baking, Brandee is a woman whose joy lights up a room with her smile and laugh. With her cheerful, friendly personality, it's no wonder Brandee makes such a wonderful community acupuncturist, healer and leader.

www.denverunityacupuncture.com

www.denverunityacupuncture.com

Brandee - OIF-1.png
Brandee - OIF-2 .png
Brandee - OIF-3.png
 

POINT TO POINT COMMUNITY ACUPUNCTURE - Jill Nielsen-Farrell

Jill, Jill, Jill. Easily one of my favorite human beings. This woman is a beast, managing a clinic, doing her herbal training courses and caring for her family with two boys. The most incredible thing about Jill is her unwavering optimism, joy and energetic presence. She's so full of love and light and I consider her a much cherished friend.

www.p2pcommunityacupuncture.com

www.p2pcommunityacupuncture.com

Jill - OIF-1 .png
Jill - OIF-2 .png

Love the branding, the colors and general overall look. Aesthetically pleasing :) short, sweet and looking beautiful!

 

MINDFULNESS COMMUNITY ACUPUNCTURE - Minh T. Nyugen

Words I would use to describe Minh would be sweet and caring. She has a calming presence about her. Minh is not only a visionary but also a hardworking go-getter. Balanced with her gentle and beautiful spirit, it is no wonder she makes a wonderful community acupuncturist, mother and healer.

https://www.facebook.com/MindfulnessCommunityAcu/

https://www.facebook.com/MindfulnessCommunityAcu/

Minh - OIF.png

The thing I like about this intake form is there is a lot of room and space for patients to give more detail. Great job Minh!

 

STRAIGHT TO THE POINT COMMUNITY ACUPUNCTURE - Paul Kohlmeier

Hardworking and of extremely high standards, Paul is a great leader and manages to accomplish so much because of his passion he brings to his work and the standards he exemplifies to his team. It is always a pleasure talking with Paul for he is a fun, innovative and incredibly open minded person. 

www.sttpca.com

www.sttpca.com

Paul - OIF-1 .png
Paul - OIF-2 .png
Paul - OIF-3 .png

Love how everything is boxed into appropriate categories. Allows for a quick and smooth filling out process for new patients :) simple and speedy!

 

MELBOURNE COMMUNITY ACUPUNCTURE - Annye Williams

The doting mother of two young children, Annye is nurturing, decisive and has an aptitude for perfection. She is grounded and realistic, whilst also holding a lot of faith in people. I don't know how she does it. It's like she's wonder woman -  being a mother whilst growing as a community acupuncturist and clinic owner.

www.melbourneca.com

www.melbourneca.com

I love how beautifully presented this looks and the way it is formatted. I also like the use of images to allow patients to visually indicate where there is pain on their body. Love it!

 

WINDSTONE ACUPUNCTURE - Stephanie Trzaska

Steph is a very cool woman. She's well traveled, visited to many places in China and she's open minded, gracious and just an enjoyable person to be around. She easily makes people feel at home (including me) and is such a great conversationalist that it's no wonder her patients choose to stay with her. She is bubbly, friendly and an all round lovely person. 

www.windstoneacupuncture.net

www.windstoneacupuncture.net

Stephanie - OIF.png
Stephanie - OIF 1.png

Super sweet and simple. Fast and to the point. Also like to note the section pertaining specifically to Colorado state laws. Love that - great job Stephanie! :)

 

THE ZEN DEN - Melissa Skelly

Kind and beautiful, Melissa is someone whom you can tell she cares about her patients a whole lot. Her and Jenn have been such great communicators and just amazing with me. When you meet her, you can immediately tell she brings not just her skills as an acupuncturist into her clinic but also her huge heart. She is the embodiment of a caring, empathetic healer.

www.thezendencenter.com

www.thezendencenter.com

With the longest intake form, Melissa's layout includes many components of the ones above. With the more thorough in depth questions, this intake form will be great for those who want as much detail from their patients as possible. Very cool!

 

Hopefully you'll get some awesome inspiration if you've decided over the weekend to give your own intake forms a makeover!

Thank you so so much to our gracious, amazing Happy Charting community acupuncturists who shared their intake forms. You guys are seriously the bees knees :D

Lots of love, 

The Happy Charting Team

Maxie Ouyang