Write the form
Build it with short and long text, yes or no, dates, numbers, single and multiple choice, and scales. Preview it, then publish.
Patient intake forms software that asks your questions
Write the intake and follow-up forms your clinic actually uses, start from a ready-made new patient intake, and assign them to patients in your branded portal. Every answer lands in the chart.
15-day free trial · Unlimited patients · BAA on request
Write it, assign it, read the answers
When intake lives in a PDF or a separate form tool, someone copies the answers into the chart by hand. Here the form, the patient's answers and the chart are one system.
Assign it to the patient
Assign a form by hand, flag it as intake so it goes out when the patient activates their portal, or add it as a step in a care plan.
Read the answers
Patients answer in your white-label patient portal. The provider reads the submission exactly as the patient saw it and marks it reviewed.
Clinic-authored
The forms your clinic writes
Every clinic authors its own forms with the same builder. There is no fixed questionnaire you have to work around, and no form is shared across clinics.
Published in every new clinic, ready to edit
- Starts with
- Preferred name, pronouns, phone, medications, allergies, conditions, weight, height and a goals question.
- Reaches patients
- Flag it as intake and it is assigned when the patient activates portal access.
- Yours to change
- It belongs to your clinic from the start. Edit it, extend it, replace it or archive it.
Short questions between visits
- What it asks
- The questions your providers want answered between visits, using scales, yes or no and short text.
- Reaches patients
- Add it as a step in a care plan, and it is sent when that step comes due.
- Where answers go
- The submission sits in the chart next to labs, notes and the plan the patient is working through.
The longevity questions a diagnosis list misses
- What it asks
- Sleep, stress, training, supplements, family history and goals, worded the way your clinic practices.
- Fewer questions
- Show a question only when an earlier answer calls for it, so patients skip what doesn't apply to them.
- Patient experience
- Progress is saved as they go, so they can stop and come back to a long form.
What changed since the last visit
- Reaches patients
- Assign it by hand before a visit, from the patient's chart.
- Record fields
- Tie questions to the record, so new medications land in the history and weight or blood pressure become new dated readings.
- Old answers
- Earlier readings are never written over, and every past submission stays readable.
No retyping
Answers that update the patient's record
A question can be tied to a field on the patient's record. When the patient submits, the answer is written there for you, and the submission keeps the original answer as well.
- Preferred name, pronouns and phone update the patient's profile.
- Medications, allergies and conditions are added to the patient's history, marked as reported by the patient.
- Weight, height, waist and blood pressure are saved as new dated readings, never written over earlier ones.
Show-if rules
Patients only see the questions that apply
Set a rule on any question so it appears only when an earlier answer calls for it. A longevity intake can cover a lot of ground without feeling long.
Built to last
Forms you can change without losing old answers
Edit a form a year from now and every earlier submission still reads exactly as the patient answered it.
- Publishing freezes the version, so what you reviewed is exactly what patients see.
- Editing a published form opens a new draft. Every answer stays tied to the version the patient actually answered.
- Retiring a form archives it instead of deleting it. Forms already sent can still be finished, and you can restore it later.
- Every submission stays readable, including answers to forms you have since archived.
- Form answers are patient data. Each time staff open a submission, the read is recorded in the audit trail.
Digital consent forms are on the roadmap
Consent forms tied to each service package, signed in the patient portal, are on the roadmap. Today forms collect answers, not e-signatures. See the rest of the platform.
Patient data, handled like it matters
Your patients’ data is never used to train AI models, and every extracted value is checked by your team before it reaches the chart.
How we protect patient data- HIPAA compliantRole-based access and an audit trail on clinical data
- BAA on requestWe sign a Business Associate Agreement
- Tenant-isolated dataEach clinic's records are walled off from every other clinic's
Can I build my own patient intake form in LongevityEHR?
Yes. Each clinic writes its own forms with a builder that supports text, yes or no, dates, numbers, choice and scale questions, plus rules that show a question based on an earlier answer.
What does the default new patient intake ask?
Every new clinic starts with a published New patient intake covering preferred name, pronouns, phone, medications, allergies, conditions, weight, height and a goals question. It belongs to your clinic, so you can edit, extend or archive it.
How do patients complete online patient intake?
In your branded patient portal. A form flagged as intake is assigned when the patient activates portal access, and their progress is saved so they can finish later.
What happens to old answers when I edit a form?
Nothing changes for them. Publishing freezes a version, and every submission stays tied to the exact version the patient answered.
Does LongevityEHR support digital consent forms?
Not yet. Digital consents signed in the portal are on the roadmap. See what else is coming on the platform page.
Keep exploring
Intake that reads like your clinic wrote it
Start a free trial and send your own new patient intake from your branded portal.