PERMISSIONS: Administrator permissions are required to build and activate custom intake forms.
Custom Intake Forms allow you to build customized online forms, send those forms to patients or caregivers who can fill them out in the patient portal, then import information from the form back into the patient record.
Jump to Section:
Create a Custom Intake Form
You must be an administrator to build a custom intake form. Once a custom intake form has been created and activated, anyone with access to a patient can send the custom intake form to portal users for that patient, or review custom intake forms that have been filled out and submitted back to the clinic.
- From the Admin tab, click Advanced Setup in the menu bar and select Intake Forms.
- Click the +Custom Intake Form button in the lower right corner.
- Enter a Name for the Form.
- Optional: Enter a Description to help staff understand what each form contains or when it should be used.
- Optional: Click the Requested Files tab to allow portal users to upload files when completing their intake form.
- Select Yes from the Request Files dropdown.
- Enter a File Label.
- Click + File to add additional file upload options.
- Click the Save Custom Intake Form button to open the custom intake form builder.
- Click and Drag Form Items from the Form Item list on the left into the black space on the right.
NOTE: Once you have multiple items on the form, you can reposition them by clicking and dragging the move handle that appears in the left hand corner when you hover over the form item.
- Fill in the Form Item Settings for each Form Item.
- Click the Save Intake Form button.
Form Item Types
Heading
Add Headings to your form to visually group form items, sections or fields.
Short Text Field
The Short Text Field allows the portal user to type a short response or small amount of text. You can use the Short Text Field to ask for short descriptions or basic information.
Long Text Field
The Long Text Field allows the portal user to type a longer response or larger amount of text, and automatically expands down as they type so more text can be seen at once. You can use the Long Text Field to ask for larger descriptions or observations.
Date Field
The Date Field allows the portal user to type a date in or select a date from a calendar.
DropDown
Dropdowns allow the portal user to select one option from a dropdown list. Users can select only one and not multiple choices from a Dropdown. You can use Dropdowns for controlled selections, preset options and yes/no questions.
Radio Buttons
Radio Buttons allow the portal user to select one option from a list by clicking a radio button. Users can select only one and not multiple choices from a list of Radio Buttons. You can use Radio Buttons for controlled selections, preset options and yes/no questions.
Checkboxes
Checkboxes allow the portal user to select multiple options from a list. You can use Checkboxes to allow users to make selections from lists of things such as symptoms or levels of impairment. You can also include a custom option to allow users to type in their own response.
Table
Tables allow you to group multiple fields of related information by displaying the fields as side-by-side columns within the same table. Tables give you the option to include text, radio buttons, checkboxes, dates and pictures. You can use Tables for items that have multiple responses or grouped information. For more information, check our Knowledge Base Article Add a Table to a Custom Intake Form.
Picture
Pictures allow you to upload a picture that will appear on the form. You have the option to turn on annotations, which allow the portal user to point out areas on the picture and add notes about them. You can use this for body pictures and give the portal user the ability to note specific information at a given point on the picture.
Description Text
Description Text allows you to type a longer area of text for the portal user to read. You can use this for things like instructions, further explanations and policy information.
NOTE: You must manually type the Description Text. If you copy and paste text into this field, your Description Text will not display properly on the form.
Patient Fields
Patient Fields are associated with the patient in the system, so the information the portal user fills out in Patient Fields can be imported back to the patient’s record.
Signature
Signature allows the user to click to type a signature.
Form Item Settings
Form Item settings allow you to customize form item size, requirements, information and options. Not all settings are available for all Form Item types.
Form Item Setting | Definition and Function |
| Label | The name of the field that appears on the form. |
| Options | The responses the portal user can choose from. |
| Field Width | Field Width can be set to Half or Full. Half Width items can be placed beside each other. |
| Field Required | The portal user will have to fill in a required field before the intake form can be submitted back to the clinic. |
| Custom Option | Allows the portal user to type in their own response for item types that include Custom Options. |
Activate Custom Intake Form
Custom intake forms must be activated to make them available to send to portal users.
- From the Admin tab, click Advanced Setup in the menu bar and select Intake Forms.
- Click the Reactivate icon on the right side of the form.
- Click the Reactivate Intake Form button.