Medium

Available on

Apple Android Windows

Patient Intake Information Mobile App

The Patient Intake Information mobile app for intake coordinators and others involved in medical care makes it easy to capture all important patient details electronically. Say goodbye to paper patient intake forms that need to be manually inputted into your electronic health information system. The app simplifies the patient intake process - just generate a new form using your smartphone or tablet, and you'll have access to an electronic patient intake form that can be printed off as a PDF document and given to nursing staff and physicians.

Reduce paper work and improve medical care by tracking all important patient details electronically. The intake form app can be used to assist health care providers who are treating patients after a car accident, to help manage new patients in physical therapy clinics and to track patient care in mental healthcare facilities. With the app, it's always easy to generate new patient intake forms in any setting.

There are even more best-selling patient management apps you might enjoy!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Patient Intake Information Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Retainer Date

  • Ico textbox

    Retainer Code

  • Ico date

    Date of Accident

  • Ico time

    Time

  • Ico dropdown

    Day of Week

  • Ico textbox

    Weather

  • Ico textbox

    Location of the Accident

  • Ico textbox

    Sex

  • Ico textbox

    SS#

  • Ico textbox

    Spouse/Guardian

  • Ico textbox

    D.

  • Ico textbox

    SS#

  • Ico multiline

    Current Home Address

  • Ico textbox

    Home Phone

  • Ico textbox

    Cell Phone

  • Ico textbox

    Work Phone

  • Ico textbox

    E-mail

  • Ico dropdown

    Marital Status

  • Ico dropdown

    Employment Status

  • Ico textbox

    Employer's Name

  • Ico textbox

    Work History

  • Ico multiline

    Employer's Address

  • Ico textbox

    Work Days / Week

  • Ico textbox

    Work Hours / Day

  • Ico textbox

    Wages or Salary

  • Ico dropdown

    Check/Cash

  • Ico textbox

    Occupation

  • Ico textbox

    Plaintiff Name

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Addiction Behaviors Checklist

The Addiction Behaviors Checklist mobile app offers a helpful list of behaviors to look for when assessing patients who us...

App Name

Pain Assessment Checklist for Seniors...

The Pain Assessment Checklist for Seniors with Limited Ability to Communicate mobile app was developed to help care givers...

App Name

Brucellosis Case Report California CD...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Botulism Case Report California CDPH ...

The Botulism Case Report California CDPH 8547 mobile app makes it easy to track important details when a diagnosis of botu...

App Name

Pain Questionnaire: Low Back

When your back hurts, you may find it difficult to do some of the things you normally do. Use the Pain Questionnaire: Low ...

App Name

Ehrlichiosis/Anaplasmosis Case Repor...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Sample Letter For Gender Reassignment...

Gender reassignment surgery is becoming a common procedure. Surgery for transitioning from male to female or female to mal...

App Name

Pain Management Center Authorization ...

The Pain Management Center Authorization Release Form mobile app allows patients to authorize the release of healthcare in...

More Information