Form preview

Get the free Adult New Patient Intake template

Get Form
Complete the Adult New Patient Intake Form for Empowering Choices Counseling to provide essential personal information for effective counseling services.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign adult new patient intake

Edit
Edit your adult new patient intake form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your adult new patient intake form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing adult new patient intake online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Here are the steps you need to follow to get started with our professional PDF editor:
1
Check your account. It's time to start your free trial.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit adult new patient intake. Rearrange and rotate pages, add and edit text, and use additional tools. To save changes and return to your Dashboard, click Done. The Documents tab allows you to merge, divide, lock, or unlock files.
4
Get your file. Select the name of your file in the docs list and choose your preferred exporting method. You can download it as a PDF, save it in another format, send it by email, or transfer it to the cloud.
pdfFiller makes dealing with documents a breeze. Create an account to find out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out adult new patient intake

Illustration

How to fill out adult new patient intake

01
Obtain the new patient intake form from the receptionist or online portal.
02
Fill out personal information such as name, address, contact number, and emergency contact.
03
Provide details about your medical history, past surgeries, current medications, and allergies.
04
Answer questions about your current health status, reason for visit, and any specific concerns.
05
Sign and date the form to confirm the accuracy of the information provided.

Who needs adult new patient intake?

01
Any adult who is a new patient at the medical facility or healthcare provider needs to fill out the adult new patient intake form.

What is Adult New Patient Intake Form?

The Adult New Patient Intake is a Word document needed to be submitted to the specific address to provide specific information. It needs to be filled-out and signed, which can be done in hard copy, or with a certain solution such as PDFfiller. This tool lets you complete any PDF or Word document directly in your browser, customize it depending on your needs and put a legally-binding e-signature. Once after completion, the user can send the Adult New Patient Intake to the appropriate recipient, or multiple recipients via email or fax. The editable template is printable too because of PDFfiller feature and options proposed for printing out adjustment. Both in digital and in hard copy, your form will have got neat and professional outlook. It's also possible to turn it into a template to use it later, there's no need to create a new file again. All you need to do is to edit the ready form.

Instructions for the Adult New Patient Intake form

Before filling out Adult New Patient Intake Word form, make sure that you prepared enough of required information. It's a important part, because some errors can bring unpleasant consequences starting with re-submission of the entire word template and filling out with missing deadlines and you might be charged a penalty fee. You should be especially careful when working with digits. At first glance, you might think of it as to be quite simple. But nevertheless, it's easy to make a mistake. Some people use such lifehack as saving everything in another document or a record book and then attach this into documents' temlates. Nevertheless, try to make all efforts and present accurate and solid info in Adult New Patient Intake form, and check it twice during the process of filling out all fields. If it appears that some mistakes still persist, you can easily make some more corrections when working with PDFfiller editor and avoid blown deadlines.

Adult New Patient Intake word template: frequently asked questions

1. I have some sensitive files to fill out and sign. Is there any risk another person would have got access to them?

Products working with personal information (even intel one) like PDFfiller do care about you to be confident about how secure your documents are. They include the following features:

  • Private cloud storage where all information is kept protected with both basic and layered encryption. This way you can be sure nobody would have got access to your personal data but yourself. Doorways to steal this information by the service is strictly prohibited.
  • To prevent document faking, each document receives its unique ID number once signed.
  • If you think this is not safe enough for you, set additional security features you like then. They manage you to request the two-factor authentication for every person trying to read, annotate or edit your file. PDFfiller also provides specific folders where you can put your Adult New Patient Intake word template and encrypt them with a password.

2. Have never heard of electronic signatures. Are they similar comparing to physical ones?

Yes, it is absolutely legal. After ESIGN Act concluded in 2000, an e-signature is considered legal, just like physical one is. You can fill out a word file and sign it, and it will be as legally binding as its physical equivalent. You can use digital signature with whatever form you like, including fillable form Adult New Patient Intake. Make sure that it suits to all legal requirements like PDFfiller does.

3. Can I copy the available information and transfer it to the form?

In PDFfiller, there is a feature called Fill in Bulk. It helps to export data from file to the online template. The key advantage of this feature is that you can use it with Excel spread sheets.

Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.8
Satisfied
46 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Once your adult new patient intake is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.
With pdfFiller, you may easily complete and sign adult new patient intake online. It lets you modify original PDF material, highlight, blackout, erase, and write text anywhere on a page, legally eSign your document, and do a lot more. Create a free account to handle professional papers online.
Use the pdfFiller mobile app to complete and sign adult new patient intake on your mobile device. Visit our web page (https://edit-pdf-ios-android.pdffiller.com/) to learn more about our mobile applications, the capabilities you’ll have access to, and the steps to take to get up and running.
Adult new patient intake is the process of collecting information from new patients who are adults seeking medical care for the first time at a healthcare facility.
New adult patients who are seeking medical services for the first time are required to complete the adult new patient intake form.
To fill out the adult new patient intake, patients typically need to provide personal information, medical history, current medications, allergies, and insurance details. This usually involves completing a form provided by the healthcare facility.
The purpose of adult new patient intake is to gather essential information to provide tailored healthcare, understand the patient's medical history, and ensure proper treatment planning.
Information that must be reported includes personal details (name, date of birth, contact information), medical history, current medications, known allergies, family medical history, and insurance information.
Fill out your adult new patient intake online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.