Well Aligned forms were created by chiropractors, for chiropractors – so each form is concise and efficient. This DIGITAL Pediatric Intake Form features the following sections to ensure you have all the patient info you need. Nothing more. Nothing less. After all, you only get one chance to make a professional first impression!

Pediatric Intake Forms include:

  • Confidential Patient Information
  • Current Health Conditions
  • Health Goals for Your Child
  • Pregnancy & Fertility History
  • Labor & Delivery History
  • Growth & Development History
  • Acknowledgment & Consent
  • Customized content area for your practice info

Key Features of all DIGITAL First Impressions Pro Forms:

  • PDF office forms that can integrate any way you want to fit your practice and systems.
  • Fillable PDFs can be downloaded, emailed, printed or even completed on a tablet.
  • Clean and modern forms are customized with your practice information for a professional look.
  • Collect only the most pertinent patient information, making it faster and easier for patients to complete.
  • Organization and layout of information make it functional and efficient for chiropractors and staff to process.

What you get:

Your digital order will include a link to download a PDF file that can be implemented as you wish.

International orders:

We’ve got you covered! We have templates available for Canada, Australia, New Zealand and UK customers to accommodate for state/province, zip/postal code, and other pertinent identification numbers so that they’re formatted properly for your respective country. Just mention it when you complete the customization form after checkout.

Learn more about Digital Forms, view FAQs and more

1 review for DIGITAL Pediatric Intake Form

  1. Connected Family Chiropractic (verified owner)

    Love the digital forms. More cost effective in the long run and patients give more information when they can fill it out from their own home/computer.
    Had some difficulty uploading to intakeq but WAP was super helpful in helping us out!

Add a review

Your email address will not be published. Required fields are marked *

You may also like…