Intake form
Clinical reviewer: Elena Gizzi, MSN, RN · Last checked September 24, 2026
What is a medical intake form?
Intake form refers to the document a patient fills out to record their medical history, including allergies, illnesses, surgeries, medicines, and health habits, before or at the start of care. A family medical history section may also ask about health conditions in close relatives, per the National Cancer Institute.
What does an intake form collect?
Most of an intake form is medical history, which the National Cancer Institute describes as information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests, plus medicines taken and health habits such as diet and exercise [1]. It may also include a family medical history covering close relatives, such as parents, grandparents, children, and siblings [1].
Why does form design matter?
Practices often ask patients to fill out forms or read written materials [2]. Almost a quarter of U.S. adults have low literacy and a third have low numeracy, and the average reading level for U.S. adults is 8th or 9th grade [2]. Good forms ask only for "need to know" information, and ask for it only once, sharing it with everyone on the care team instead of repeating the request [2].
Why does a GLP-1 intake form ask about family history?
Because the Wegovy label lists a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 as a contraindication [3], a medical history question about thyroid cancer in the family is one way that history can be identified before treatment starts.
Frequently asked questions
Why might a form ask about my family members' health, not just mine?+−
A family medical history, as defined by the National Cancer Institute, includes health information about close relatives — parents, grandparents, children, and siblings — alongside your own personal history.
Why should an intake form be easy to read?+−
AHRQ reports that almost a quarter of U.S. adults have low literacy and a third have low numeracy, and that the average reading level for U.S. adults is 8th or 9th grade.
Related terms
Sources
This entry is for education and is not medical advice. Talk with a licensed clinician about your own situation before starting, stopping, or changing any treatment.
