ENT New Patient Intake Form

Professional ENT Patient Intake Made Simple

For ENT practices, gathering comprehensive patient information before the first appointment is crucial for accurate diagnosis and effective treatment planning. This ENT New Patient Intake Form template streamlines your patient onboarding process by collecting detailed information about hearing loss, sinus symptoms, voice changes, balance issues, and relevant medical history—all before the patient walks through your door.

Built for Otolaryngology Practices

Whether you're a solo ENT physician, part of a multi-specialty clinic, or managing an audiology practice, this template is designed to capture the specific details that matter for ear, nose, and throat conditions. The form includes sections for:

• Demographic and insurance information to streamline registration
• Comprehensive symptom assessment covering hearing, sinus, throat, and balance issues
• Hearing loss evaluation with specific questions about onset, severity, and impact
• Medical and surgical history relevant to ENT conditions
• Current medications and allergies for safe treatment planning
• Quality of life impact to understand how symptoms affect daily activities

Improve Patient Care and Office Efficiency

By having patients complete this form online before their appointment, your front desk staff spend less time on paperwork and more time providing personal care. Your physicians get a complete picture of the patient's condition before the exam, leading to more focused consultations and better outcomes.

The form uses conditional logic to show relevant follow-up questions based on symptoms reported, ensuring you gather detailed information only when needed without overwhelming patients with unnecessary questions.

Seamless Integration with Your Practice Management System

Paperform integrates with popular healthcare tools and CRMs, allowing you to automatically route patient intake data into your electronic health records system. You can also use Stepper (stepper.io) to create automated workflows that trigger appointment confirmations, send pre-appointment instructions, or alert staff when high-priority cases are submitted.

For practices requiring legally binding consent forms, Papersign (papersign.com) allows you to send treatment consent documents or privacy acknowledgments for electronic signature immediately after intake submission, keeping all documentation organized in one place.

HIPAA Considerations

Please note that while Paperform is SOC 2 Type II certified and provides robust security features, it is not a HIPAA-compliant solution. For practices requiring HIPAA compliance, please ensure you have appropriate safeguards and business associate agreements in place with all technology vendors in your workflow.

Trusted by Healthcare Professionals

Join thousands of healthcare providers using Paperform to modernize their patient intake process. With a professional, on-brand design that works perfectly on any device, your patients will appreciate the convenience while your practice benefits from organized, complete patient data from day one.