Pain Management Clinic Intake Form

Streamline Your Pain Management Clinic Intake with Paperform

Managing a pain management clinic requires detailed patient information to develop effective treatment plans. This Pain Management Clinic Intake Form template provides a comprehensive, professional solution for collecting essential patient data, pain assessments, and medical history—all in one organized digital form.

Built for Pain Management Specialists

This template is specifically designed for pain management clinics, anesthesiologists, physiatrists, and multi-disciplinary pain centers. It captures everything you need for a thorough initial consultation: demographic information, detailed pain assessment using validated scales, complete medication history, previous interventions, and quality of life measurements.

The form includes visual pain intensity scales, body diagrams for pain location mapping, and structured questions about functional limitations—giving you a complete picture before the patient even walks through the door. Conditional logic ensures patients only answer relevant follow-up questions, making the experience smoother while capturing more detailed information where it matters.

Save Time and Improve Patient Care

By digitizing your intake process with Paperform, you eliminate illegible handwriting, reduce data entry errors, and ensure no critical information is missed. Submissions sync directly to your practice management system, EHR, or Google Sheets, making it easy to review patient information before appointments and maintain organized records.

With Paperform's Papersign integration (papersign.com), you can seamlessly convert intake form submissions into consent forms and treatment agreements that require patient signatures—keeping all documentation connected and creating a complete audit trail from intake to treatment.

Secure, Compliant, and Professional

Patient data security is paramount in healthcare. Paperform is SOC 2 Type II compliant and GDPR compliant, with data encryption, secure submissions, and configurable data residency controls. While Paperform is not HIPAA compliant, it provides enterprise-grade security suitable for many healthcare administrative workflows.

Customize the form to match your clinic's branding with custom colors, fonts, and your logo. Embed it directly on your website, send it via email before appointments, or share a link through your patient portal. Success messages can include helpful next steps, parking information, or pre-appointment instructions.

Workflow Automation Made Simple

Use Stepper (stepper.io) to automate what happens after a patient submits their intake form. Automatically create patient records in your system, send confirmation emails with appointment details, notify your clinical team about high-priority cases, or trigger different workflows based on pain severity or specific conditions reported.

Over 500,000 teams worldwide trust Paperform to handle their most important forms. Join pain management clinics already using this template to deliver better patient experiences and more efficient intake processes.