Templates
Miscellaneous
Patient Intake Checklist for a Dental Clinic

Patient Intake Checklist for a Dental Clinic

Run this checklist for each new dental patient to make the intake process as easy as possible for them.
1
Introduction:
2
Basic information:
3
Input basic information
4
Declare required documents
5
Request additional insurance information
6
Compliance:
7
Upload HIPAA authorization form
8
Upload bill of patient rights and responsibilities
9
Upload consent to dental procedures form
10
Send HIPAA authorization form
11
Send bill of patient rights and responsibilities
12
Send consent to dental procedures form
13
Receive signed HIPAA authorization form
14
Receive signed consent to dental procedures form
15
Receive signed bill of patient rights and responsibilities
16
Dentistry CRM:
17
Create new patient profile in dentistry CRM
18
Ask patient for changes to their information
19
Record changes to patient information
20
Determine additional documents needed
21
Update dentistry CRM with new information
22
Welcome:
23
Prepare welcome email
24
Send welcome email
25
Scheduling:
26
Schedule intake appointment
27
Confirm appointment date
28
Dental history:
29
Send oral health questionnaire
30
Receive completed oral health questionnaire
31
Preparation for appointment:
32
Prepare directions to clinic
33
Provide directions to clinic
34
Request they bring additional documents to the appointment
35
Intake appointment:
36
Understand patient's needs
37
Post-appointment:
38
Upload proof of identification
39
Upload dental history documents
40
Upload insurance documents
41
Upload documents (other)
42
Determine next steps
43
Inform patient of next steps
44
Update dental CRM
45
Insurance:
46
Check insurance coverage
47
Provide payment options
48
Sources:
49
Related checklists: