Health History Intake Form Pain Clinic

Form Template

The Health History Intake Form Pain Clinic mobile app allows pain clinics to complete a patient intake form using a Smartphone, tablet or desktop.

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The Health History Intake Form app documents a variety of patient details, including location of pain, surgical history, previous medical problems, symptoms, primary care physician, use of recreational drugs and more.

The pain clinic care provider can add extra details into the patient intake form, including the additional health concerns and treatment plan recommendations. Gathering these details electronically can help when development a new treatment plan for managing pain symptoms and helps ensure that no details are missed. Once the health history intake form is complete, both the patient and care provider can sign off on the information electronically and save it for their patient's medical records. You can use a field in your app to name your submission.

Features
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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