Brazilian Healthcare Patient Intake Form

Streamline Your Brazilian Private Clinic Patient Intake with Paperform

Running a private healthcare clinic in Brazil means juggling patient documentation, regulatory compliance, and delivering quality care—all while maintaining detailed records that meet Brazilian health standards. Whether you're operating a small family practice, a specialized clinic, or a multi-practitioner facility, your patient intake process sets the tone for the entire care experience.

This Brazilian Healthcare Patient Intake Form template is specifically designed for private clinics across Brazil, helping you collect essential patient information including CPF, SUS card details, medical history, and consent documentation in one streamlined, professional form. Instead of managing paper forms, scattered data entry, and manual filing, you can digitize your entire intake process while staying compliant with Brazilian healthcare regulations.

Built for Brazilian Healthcare Workflows

This template captures everything your clinic needs from new patients:

• Patient identification with CPF (Cadastro de Pessoas Físicas) and RG documentation
• SUS card number for patients who also use the public healthcare system
• Contact and emergency information formatted for Brazilian addresses and phone numbers
• Comprehensive medical history including chronic conditions, allergies, current medications, and previous surgeries
• Family medical history to understand hereditary health patterns
• Lifestyle assessment covering exercise, diet, smoking, and alcohol consumption
• Current symptoms and reason for visit to help prepare for the consultation
• Insurance and payment information for private health plan holders
• Consent and authorization for treatment, data processing (LGPD compliance), and information sharing

For clinics serving diverse patient populations—from pediatrics to geriatrics, general practice to specialized care—this form provides a flexible foundation you can customize to your specific medical focus.

Why Paperform for Brazilian Healthcare Clinics

Brand consistency matters in healthcare. Patients trust clinics that present a professional, organized image from first contact. With Paperform's doc-style editor, you can match your intake form to your clinic's branding with custom colors, fonts, logos, and imagery. Embed the form directly on your clinic website, share it via WhatsApp or email before appointments, or use it on tablets in your waiting room.

Conditional logic keeps forms patient-friendly. Not every patient needs to answer every question. Use Paperform's conditional logic to show relevant follow-up questions based on previous answers—for example, only asking about pregnancy-related information when applicable, or diving deeper into specific chronic conditions a patient indicates they have. This creates a more intuitive experience that respects patients' time.

LGPD compliance built in. Brazil's Lei Geral de Proteção de Dados (LGPD) requires explicit consent for processing personal health information. This template includes clear consent language, and Paperform's SOC 2 Type II compliance and data residency controls give you the security foundation your clinic needs. Store patient data securely, control who on your team has access, and maintain audit trails of form submissions.

Automate Your Clinical Workflows with Stepper

Once a patient submits their intake form, the real work begins—and that's where Stepper transforms your operations. Instead of manually copying patient information into your practice management system, sending welcome emails, creating medical records, and scheduling follow-ups, let automation handle the routine tasks.

With Stepper, you can:

• Route new patient submissions to the appropriate practitioner or department based on their reason for visit or insurance type
• Create patient records automatically in your EMR or practice management system (like PEP, MV, Tasy, or others)
• Send personalized welcome messages via email or WhatsApp with appointment details, clinic directions, and what to bring
• Alert your team in Slack or via SMS when urgent cases come through requiring immediate attention
• Update your appointment calendar and sync patient information across Google Workspace or Microsoft 365
• Trigger follow-up workflows for incomplete forms, missing documentation, or patients who need lab work before their visit

This means your front desk staff spend less time on data entry and more time providing the warm, personal care that sets your clinic apart.

Designed for Brazilian Healthcare Professionals

Whether you're a physician running a solo practice, a clinic administrator managing multiple practitioners, a nurse coordinating patient care, or a healthcare entrepreneur building a network of clinics, this template addresses the specific documentation requirements of Brazilian private healthcare.

The form collects information in formats familiar to Brazilian patients—CPF with proper formatting, SUS card numbers, Brazilian address structures, and consent language that aligns with LGPD requirements. You're not adapting a generic international template; you're starting with a form built for the Brazilian healthcare context.

Flexible, Secure, and Professional

Paperform scales with your clinic. Start with the free plan for basic intake, then move to paid tiers as your patient volume grows and you add team members. All plans maintain the same high security standards, with encryption in transit and at rest, regular security audits, and transparent privacy practices detailed in Paperform's Trust Center.

For multi-location clinics or healthcare groups, Paperform's Agency+ plan lets you manage forms for multiple clinic brands under one account, with role-based permissions ensuring each location's staff sees only what they need.

Get Patients Started Right

First impressions matter in healthcare. A professional, efficient intake process signals to patients that your clinic values their time, takes their health seriously, and operates with modern, organized systems. By digitizing your patient intake with Paperform, you reduce wait times, minimize errors from illegible handwriting, and create a more welcoming experience from the moment patients first interact with your clinic.

Ready to modernize your Brazilian private clinic's patient intake? Use this template as your starting point, customize it to your specific medical practice, and create an intake process that works as hard as you do—all without writing a single line of code.