Patient intake & consent

Turn Handwritten Patient Intake and Consent Forms into Structured Data

Photograph or scan intake, history and consent forms and get demographics, insurance, medications, allergies, signatures and consent ticks as clean JSON — with sensitive health details masked for team members who do not need to see them.

Try a sample intake form free See plans and prices

Handwriting that front desks struggle with

Cursive, ticks and crossed-out answers are read and the uncertain ones flagged.

Sensitive fields masked by role

Health details are hidden from staff who do not need them; every view is logged.

Consent you can prove

Signature presence, date and each ticked consent are captured as fields you can search.

What an extracted intake form looks like

{
  "form": "New patient intake",
  "patient": {
    "name": "Jane Example",
    "date_of_birth": "1988-03-12",
    "phone": "+1 555 0100"
  },
  "insurance": {
    "payer": "Example Health Plan",
    "member_id": "XHP448120931"
  },
  "allergies": [
    "Penicillin"
  ],
  "medications": [
    {
      "name": "Lisinopril",
      "dose": "10 mg"
    }
  ],
  "consents": {
    "treatment": true,
    "privacy_notice_received": true,
    "signed": true,
    "signature_date": "2026-09-02"
  },
  "masked_for_non_admins": [
    "medications",
    "allergies"
  ]
}

How to digitize intake forms

01
Scan or photograph the completed form.
02
Upload it, or drop a day's forms as one folder.
03
Check the highlighted fields.
04
Send the data to your practice software, Excel or by API.

Intake form questions

Do I need a template for my clinic's form?: No. Any layout is read; you can add a template to fix the field names you want.
Who can see the health details?: Only admins by default. Other team members see masked values.
Can patients fill it on a tablet instead?: Yes, but most clinics keep paper — Formalini reads it afterwards.
Who designed the compliance workflow?: Marco Irinel Pascalini, a HIPAA-certified professional who has run HIPAA programmes for several companies. Files are encrypted, each workspace is isolated, clinical fields can be masked by role and every view is logged. The platform itself has no third-party certification; talk to us about a business associate agreement before uploading real patient data.