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Patient Intake Form Spreadsheet Template

Collects new patient information like medical history and personal details.

Patient Intake Form
Purpose: Please complete this form with accurate personal and medical details to help us serve you better.

Personal Information
Full Name:	{fullName}
Date of Birth:	{dateOfBirth}
Gender:	{gender}
Phone Number:	{phoneNumber}
Email Address:	{email}
Address:	{address}
Emergency Contact Name:	{emergencyContactName}
Emergency Contact Phone:	{emergencyContactPhone}

Insurance Information
Insurance Provider:	{insuranceProvider}
Policy Number:	{policyNumber}
Group Number:	{groupNumber}

Medical History
Do you have any allergies?	{allergies}
Are you currently taking any medications?	{medications}
Do you have any chronic conditions?	{chronicConditions}
Have you had any surgeries?	{pastSurgeries}
Primary Physician Name:	{primaryPhysician}
Last Visit Date:	{lastVisitDate}

Family Medical History
Relation	Condition
{#familyHistory.relation}	{#familyHistory.condition}

Current Symptoms
Symptom	Severity (1-10)	Duration (in days)
{#currentSymptoms.symptom}	{#currentSymptoms.severity}	{#currentSymptoms.duration}

This document template includes dynamic placeholders for automated document generation with Documentero.com. Excel Template - Free download

Download Excel Template (.XLSX)

Customize Template

Download the Patient Intake Form template in .XLSX format. Customize it to suit your needs using your preferred editor (Excel, Google Sheets...).

Upload & Configure

Upload the template to Documentero - Document Generation Service, then map and configure template fields for your automated workflow.

Generate Documents

Populate templates with your data and generate Excel (XLSX) documents using data collected from shareable web Forms, APIs, or Integrations.

Use Cases

Automate Patient Intake Form Using Forms

create patient intake form from web form submissions

generate personalized patient intake spreadsheet from online form

build HIPAA-compliant patient form to auto-fill Excel template

collect medical history online and export to Excel intake sheet

generate patient registration spreadsheet from digital intake form

Generate Patient Intake Form Using APIs

auto-create patient intake Excel file via API from EHR system

trigger patient intake spreadsheet generation from custom CRM

generate patient information sheet in Excel with API call

automatically fill patient intake form using REST API data

send electronic patient data to generate Excel intake template

Integrations / Automations

generate patient intake Excel from Typeform responses via Zapier

create intake spreadsheet in Excel using Google Forms and Make

automatically populate patient intake form from Jotform to Excel

use Airtable data to generate patient intake Excel via automation

sync new patient entries from HubSpot to intake spreadsheet

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