What a hormone or functional medicine intake form should ask

A hormone or functional medicine intake should run in two parts. Before booking, ask a few routing questions: service, state, age, labs and how the patient pays. After booking, collect contact details, consents, goals, history, current medications and lab history in one form. Leave clinical detail for the consult, and host every part in a tool that signs a BAA.

This guide is for owners of solo cash-pay hormone, weight-loss and functional medicine practices. It covers how the form is built, not which clinical questions to ask. Your clinician should finalize the clinical sections. It fits into the patient flow a new cash-pay practice needs, between the first inquiry and the lab fee.

Why the structure matters more than the questions

Most intake problems are about order and length, not missing questions. A patient who gets four separate forms on different days finishes some, forgets one and arrives at the consult with gaps. A patient asked forty questions before they have even booked often leaves.

A good structure does three jobs:

• It routes each patient to the right service, visit type and lab step.
• It asks for each piece of information once, at the point it is needed.
• It gives your clinician a clean summary before the consult, not a pile of PDFs.

What should you ask before booking?

Before booking, ask only what you need to route the patient and confirm you can see them: which service, which state they live in, whether they are an adult, whether they have recent labs and whether they understand the visit is cash-pay. Five to eight questions is enough.

These are routing questions. Each answer changes what happens next, so each one earns its place.

Use the state answer carefully. Telehealth licensing rules depend on where the patient is, so this question protects the practice. Your attorney or licensing board sets the rules; the form only enforces them.

Assume every answer on a patient form is health information, even "which service". Host the pre-booking questions in a tool with a BAA too, not in a free marketing form.

What to collect after booking, before the consult

After booking, send one intake form that covers everything the clinician needs to prepare. Send the link in the booking confirmation so it arrives while the patient is still engaged. Ask for it to be done two to three days before the visit.

A clear order for the sections:

1. Contact and identity. Legal name, preferred name, date of birth, address, phone, email, emergency contact, pharmacy.
2. Consents and policies. Telehealth consent, privacy notice acknowledgement, consent to text and email, and your payment, deposit and no-show policy. See the policy template in how to reduce no-shows.
3. Goals. In the patient's words: what they want to change and by when. Free text works best here.
4. Health history. The sections your clinician chooses for each service.
5. Current medications and supplements. Free text with name, amount and how often. Don't force a drop-down list; patients pick the wrong item.
6. Lab history. An upload field for recent results, plus the date of the last draw.
7. Anything else. One open question: "What else should we know before your visit?"

If labs are needed before the consult, send the lab order and the lab fee link the same day the intake is sent. We walk through the payment side in how to collect lab fees before the first consult.

Use conditional logic by service

Use conditional logic so each patient sees only the sections for their service. One form with branches is easier to maintain than four separate forms, and patients don't scroll past questions that don't apply. Most form builders and EHR forms support show and hide rules.

Functional medicine intakes run longest, because a broad systems review is part of the model. Split that form into pages with a progress bar, and let the patient save and come back.

What to leave for the consult

Leave anything that needs judgement or a conversation for the visit. The form gathers facts; the consult interprets them. A shorter form gets finished, and the clinician gets better answers by asking follow-up questions live.

• Detailed symptom timelines beyond a short free-text answer.
• Treatment preferences and options.
• Sensitive history the patient may prefer to discuss in person. Offer a "Prefer to discuss at my visit" option where your clinician agrees.
• Anything a patient is likely to answer wrong without context.

Where should you host the intake form?

Host it in your EHR if the EHR's forms do what you need, because answers land in the chart with no copying. If you need more logic or a nicer layout, use a form builder that signs a BAA on the plan you pay for. Never use a free marketing form for patient answers.

For a wider list of tools, see which practice tools sign a BAA, or check your own stack with the BAA checker.

Remind patients to finish it

An unfinished intake is the most common reason a first consult starts late or gets moved. Set reminders that stop as soon as the form is submitted.

• At booking: link in the confirmation.
• 24 hours later: "Your intake takes about 15 minutes. Here is your link."
• 3 days before the visit: a second reminder, with an offer to help.
• 2 days before: a VA checks and, if it is still open, offers to move the visit.

Keep reminders free of service and health details. "Your intake form for your visit on Tuesday" is enough.

A printable outline

Use this as the skeleton for your form. It lists headings only. Have your clinician write and approve the clinical questions in each section.

Sources

• Jotform: HIPAA compliance, Gold and Enterprise plans
• Google: HIPAA compliance and covered services
• Google Workspace: HIPAA compliance with Google Workspace

This is general information, not legal advice. Confirm BAA terms with each vendor.