Intake Forms
@csrf

Send intake form to all new clients

send_intake_form_to_all_new_client) && $practitionerIntakeForm->send_intake_form_to_all_new_client == 1) checked @endif >

Customise message to client

How would you prefer to send your intake form to your clients?

SMS

send_intake_form_trough_sms) && $practitionerIntakeForm->send_intake_form_trough_sms == 1) checked @endif >

Email

send_intake_form_trough_email)) checked @endif @if(isset($practitionerIntakeForm->send_intake_form_trough_email) && $practitionerIntakeForm->send_intake_form_trough_email == 1) checked @endif @if(!isset($practitionerIntakeForm->send_intake_form_trough_email)) checked @endif>

Messaging

Use the personalisation drop down to insert code to auto populate these fields in your email

@php $intake_sms_reminder_text = isset( $practitionerIntakeForm->intake_sms_reminder_text ) && $practitionerIntakeForm->intake_sms_reminder_text != '' ? $practitionerIntakeForm->intake_sms_reminder_text : 'Dear , please complete your intake form via this link before your appointment. Thank you, '; @endphp

...
1 credit per sms. Character count for 1st message is 160 and each message thereafter 153.
Overseas numbers incur 2 credits per sms.
@php $intake_email_subject_line = isset( $practitionerIntakeForm->intake_email_subject_line ) && $practitionerIntakeForm->intake_email_subject_line != '' ? $practitionerIntakeForm->intake_email_subject_line : 'Intake form from '; @endphp
@php $intake_email_text = isset( $practitionerIntakeForm->intake_email_text ) && $practitionerIntakeForm->intake_email_text != '' ? $practitionerIntakeForm->intake_email_text : 'Dear , Please complete your intake form before your appointment. We look forward to seeing you soon. With thanks, '; @endphp

Customise intake form

Select from the following options to customise your intake form. Once complete you can preview your form.

Health History

  • health_history) && $practitionerIntakeForm->health_history == 1) checked @endif>
  • health_history) && $practitionerIntakeForm->health_history == 0) checked @endif>

Customise

The following conditions will appear on your clients form as a check box. You can remove or add new conditions as required.
@foreach($practitionerDisease as $disease)
@endforeach
...
Add to list
The following sections will appear on your clients form as you see below. You can switch them off, or add your own.

Health history details

health_history_details)) checked @endif @if(isset($practitionerIntakeForm->health_history_details) && $practitionerIntakeForm->health_history_details == 1) checked @endif>

Surgeries

surgeries)) checked @endif @if(isset($practitionerIntakeForm->surgeries) && $practitionerIntakeForm->surgeries == 1) checked @endif>

Medicines/Supplements

medicines)) checked @endif @if(isset($practitionerIntakeForm->medicines) && $practitionerIntakeForm->medicines == 1) checked @endif>

Alcohol consumption

alcohol_consumption)) checked @endif @if(isset($practitionerIntakeForm->alcohol_consumption) && $practitionerIntakeForm->alcohol_consumption == 1) checked @endif>

Smoking

smoking)) checked @endif @if(isset($practitionerIntakeForm->smoking) && $practitionerIntakeForm->smoking == 1) checked @endif>

Exercise

excercise)) checked @endif @if(isset($practitionerIntakeForm->excercise) && $practitionerIntakeForm->excercise == 1) checked @endif>

Family history

family_history)) checked @endif @if(isset($practitionerIntakeForm->family_history) && $practitionerIntakeForm->family_history == 1) checked @endif>
@foreach($healthHistoryQuestion as $historyQuestion)

{{$historyQuestion->header}}

@endforeach


Current complaint

  • health_history) && $practitionerIntakeForm->current_complaint == 1) checked @endif>
  • health_history) && $practitionerIntakeForm->current_complaint == 0) checked @endif>

Customise

The following will appear on your form. You can edit, add or delete questions.
@foreach($practitionerQuestions as $question)
@endforeach
...
Add question

Customise your own section

Have we missed something? You can add your own custom sections below. Enter the text as you wish for it to appear on your intake form.

Header

Introductory text

Questions to client

Add as many questions as you like. Answers can be either yes/no or written responses.

...
Add question

Save/add additional section

Private health fund

Did you know we have an inbuilt Hicaps terminal? By asking your clients to provide their health fund details, you can process claims online in seconds.

  • private_health_fund) && $practitionerIntakeForm->private_health_fund == 1) checked @endif>
  • private_health_fund) && $practitionerIntakeForm->private_health_fund == 0) checked @endif>

Consent

The following section asks for your clients consent to treatment. You can edit this as required.

View intake form
Client intake form

Personal Information

Emergency contact

Referral source

How did you hear about this clinic?

Health History

If you have a history of any of the following conditions, please select below.
@foreach($practitionerDisease as $disease)
@endforeach
The following sections will appear on your clients form as you see below. You can switch them off, or add your own.

Health history details

Surgeries

Medicines/Supplements

Alcohol consumption

Smoking

Exercise

Family history

Current complaint

Please provide more information about your current condition.
@foreach($practitionerQuestions as $question)
@endforeach

Upload files

Please upload any files such as test results or x-rays that you wish to share with your service provider.

Drag and drop files here

- or -

Private Health Insurance

Health Fund

Fund name

Card Number

Issue Date

Number on card

Update

Consent