Palliative Care New Patient Intake Form Template

When a patient begins palliative care, gathering comprehensive information about their medical history, current symptoms, care preferences, and support system is essential for delivering compassionate, person-centered care. A well-designed palliative care new patient intake form helps healthcare providers understand the whole person—not just their diagnosis—and creates a foundation for meaningful conversations about comfort, quality of life, and what matters most.

This Paperform template is purpose-built for palliative care teams, hospices, and supportive care programs that need to collect sensitive, detailed information in a dignified, accessible format. Instead of overwhelming patients and families with lengthy paper forms during an already emotional time, this digital intake form offers a clear, compassionate experience that respects the gravity of the moment while gathering the clinical details your team needs.

Who This Template Is For

This palliative care intake form is designed for:

Palliative care programs in hospitals, cancer centers, and community health systems
Hospice agencies onboarding new patients and their families
Supportive care clinics specializing in symptom management and quality of life
Home health teams coordinating in-home palliative services
Senior care facilities offering specialized end-of-life support
Oncology and chronic illness practices integrating palliative services into ongoing care

Whether you're a nurse navigator, social worker, chaplain, or palliative care physician, this template gives you a structured yet empathetic way to capture the information that shapes individualized care plans.

What Makes This Template Different

Traditional medical intake forms often feel transactional, focusing exclusively on symptoms and diagnoses while missing the emotional, spiritual, and relational dimensions that matter most in palliative care. This template takes a holistic approach, inviting patients and caregivers to share:

Medical history and current conditions including diagnoses, treatments, and healthcare providers
Current symptom assessment covering pain, fatigue, nausea, breathlessness, anxiety, and other quality-of-life concerns
Advance care planning preferences including advance directives, healthcare proxy designation, and communication about end-of-life wishes
Spiritual and cultural preferences to honor what brings comfort, meaning, and connection
Caregiver and support system information so your team understands who's involved in daily care and decision-making
Goals of care to align clinical interventions with what the patient values most

By collecting this depth of information upfront, your team can begin care with clarity, compassion, and a shared understanding of the patient's priorities.

Streamline Onboarding, Improve Care Coordination

Palliative care is inherently interdisciplinary—physicians, nurses, social workers, chaplains, and therapists all contribute to the care plan. This digital intake form ensures that everyone on the team has immediate access to the same foundational information, reducing repetitive questions and improving continuity of care.

With Paperform, completed intake forms can be automatically routed to your EMR, stored in secure cloud folders, or sent to specific team members based on form responses. You can use conditional logic to tailor follow-up questions based on symptom severity or care goals, ensuring that each patient's unique situation is fully understood.

And because Paperform is GDPR compliant and SOC 2 Type II certified, you can trust that sensitive patient information is handled with the highest standards of data security—though please note that Paperform is not HIPAA compliant, so teams in the US should evaluate their specific compliance requirements.

Personalize, Automate, and Scale with Confidence

Every palliative care program has its own philosophy, protocols, and patient populations. This template is fully customizable—adjust questions, add your organization's branding, incorporate specific symptom assessment scales (like the Edmonton Symptom Assessment System), or include fields for medication lists and insurance details.

Once a patient submits their intake form, you can use Stepper (stepper.io) to automate what happens next: trigger care coordinator assignments, schedule initial consultations, send welcome packets, or notify chaplains when spiritual support is requested. This automation doesn't replace the human touch—it amplifies it, ensuring no patient falls through the cracks and every family receives timely outreach.

For palliative care agencies managing multiple locations or partnering organizations, Paperform's Agency+ plan lets you manage distinct forms, branding, and workflows for each site while maintaining centralized oversight and reporting.

Why Paperform for Palliative Care Intake

Palliative care professionals are drawn to Paperform because it balances clinical rigor with human warmth. The doc-style editor makes it easy to write in a tone that feels conversational and caring, while powerful backend features like calculations, conditional logic, and integrations keep operations running smoothly.

You can embed intake forms directly on your website, send them via email to patients and families before the first visit, or share them via a simple link during a phone intake call. Completed forms can sync with tools like Airtable, Google Sheets, HubSpot, or your internal systems via integrations, keeping patient information organized and accessible to the right people.

And because Paperform forms are fully responsive, patients and caregivers can complete the intake on any device—whether they're sitting at home with a laptop, filling it out on a tablet in a waiting room, or completing it on a phone while traveling to an appointment.

Supporting Families Through Difficult Transitions

Palliative care is about more than managing symptoms—it's about honoring dignity, respecting autonomy, and supporting families through one of life's most profound transitions. A thoughtfully designed intake form sets the tone for that relationship, signaling to patients and loved ones that you see them as whole people with rich lives, complex emotions, and unique values.

This template helps you start that relationship on the right foot, collecting the clinical and personal details that allow your team to deliver truly individualized, compassionate care. Whether you're scaling a new program, transitioning from paper forms, or simply looking for a more efficient intake process, Paperform gives you the flexibility and functionality to serve patients and families with excellence.

Get started with this palliative care intake form template today and create a more compassionate, coordinated onboarding experience for every patient who walks through your door.