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.

Introduction:

Basic information:

Input basic information

Declare required documents

Request additional insurance information

Compliance:

Upload HIPAA authorization form

Upload bill of patient rights and responsibilities

Upload consent to dental procedures form

Send HIPAA authorization form

Send bill of patient rights and responsibilities

Send consent to dental procedures form

Receive signed HIPAA authorization form

Receive signed consent to dental procedures form

Receive signed bill of patient rights and responsibilities

Dentistry CRM:

Create new patient profile in dentistry CRM

Ask patient for changes to their information

Record changes to patient information

Determine additional documents needed

Update dentistry CRM with new information

Welcome:

Prepare welcome email

Send welcome email

Scheduling:

Schedule intake appointment

Confirm appointment date

Dental history:

Send oral health questionnaire

Receive completed oral health questionnaire

Preparation for appointment:

Prepare directions to clinic

Provide directions to clinic

Request they bring additional documents to the appointment

Intake appointment:

Understand patient's needs

Post-appointment:

Upload proof of identification

Upload dental history documents

Upload insurance documents

Upload documents (other)

Determine next steps

Inform patient of next steps

Update dental CRM

Insurance:

Check insurance coverage

Provide payment options

Sources:

Related checklists:

Introduction:

Using paper forms for patient intake is inefficient and troublesome.

Not only does it require more time and effort than its automated digital counterpart, but it also leaves your patients feeling more stressed, which negatively impacts long-term patient retention.

Forcing them to manually complete important documents also means patients are more likely to incorrectly fill out or omit information. What's more, much of the time their handwriting may not even be legible, which means more effort on the part of you or your front-of-desk employees to decipher and manually enter that information into your database.

This checklist provides a simpler solution, which automates much of your patient intake process and allows your patients the freedom to cooperate with you to complete the tasks digitally. With a reduction of manual entry, time spent on administrative processing is greatly reduced.

By using this checklist template you can rest assured that your patient intake process is optimized for automated efficiency, so you won't have to worry about losing time to slow patients filling their forms in on the day of their appointment. Plus, this checklist can be customized to make it the whole intake process as convenient as possible for them.

So let's get started!

Basic information:

Input basic information

Firstly, complete the form fields in this task with some basic details about your patient.

Pull patient information straight from your medical CRM and into this task with one of our 1,000+ app integrations. For example, check out this guide if you use Salesforce.

Patient first name

Patient last name

Patient date of birth

Patient contact number

Patient address

Reason for calling

Patient record exists?

Appointment booked?

Next, record what you know about the client's insurance policy.

Insurance provider

Patient policy number

Additional insurance information needed?

Declare required documents

Next, declare what documents will be required as part of routine compliance. Conditional logic will then add tasks depending on your answers.

Check out this useful resource for template dentistry documents that you could use as part of your own intake process.

Required compliance forms

Additional documents needed?

Request additional insurance information

Ask your patient for additional insurance information using the email widget in this task. Most of the information has already been filled out for you.

You can set up an integration to automatically send an email request for more information from your patient as soon as the previous task is checked.

Before you send it, check over the body of the email template to make sure all the details are applicable to your own situation.

Compliance:

Upload HIPAA authorization form

Next up, you'll need to prepare some compliance documents for sending.

Upload a copy of your HIPAA authorization form so that it can be pushed out to your client as and when needed during the onboarding process.

HIPAA confirmation form

Upload bill of patient rights and responsibilities

Upload a copy of your patient's bill of rights and responsibilities so that it can be pushed out to your client as and when needed during the onboarding process.

Check out this useful resource for template dentistry documents that you could use as part of your own intake process.

Patient bill of rights and responsibilities

Send HIPAA authorization form

Healthcare providers are required by law to follow HIPAA regulations, and you need to make sure that your patients understand how their medical records will be protected.

Send your client a HIPAA authorization form to ensure compliance when dealing with their medical records.

Automatically send an email containing a HIPAA authorization form as soon as you run this checklist by setting up a Process Street integration.

Send bill of patient rights and responsibilities

Provide your patient with a copy of the bill containing their rights and responsibilities.

Check over the body text and make sure everything looks okay before hitting the send button.

Automatically send an email with the patient's bill of rights and responsibilities as soon as you run this checklist by setting up one of our integrations.

Receive signed HIPAA authorization form

Once signed by your patient, upload the HIPAA authorization form to the form field below.

Signed HIPAA authorization form

Receive signed bill of patient rights and responsibilities

Use the file upload form field in this task to upload a copy of the signed bill of patient rights and responsibilities.

Signed bill of rights and responsibilities

Dentistry CRM:

Create new patient profile in dentistry CRM

Create a profile for your new patient inside of whichever HIPAA-compliant CRM your practice uses.

Automate patient profile creation with one of our app integrations: if you use Salesforce you can automatically create a new patient record each time you run this checklist.

Ask patient for changes to their information

Contact your patient to request any changes to their personal information.

The email widget below has passed in the basic information gathered at the start of the checklist, so they'll be able to confirm whether that is still correct and provide new details if necessary.

Record changes to patient information

Once the patient has responded to the mail sent in the previous task, record any changes to their existing information in the form field below.

New patient information

Determine additional documents needed

Determine what additional documents will be needed to proceed with the patient intake process.

Your selections in the multiple choice form field below will create new tasks for requesting the documents based on conditional logic, so you don't have to worry about manually writing up the requests for each of them.

Additional documents

1

Proof of identification
2

Dental records
3

Other (please specify)

Other (please specify)

Update dentistry CRM with new information

Patient information

First name: {{form.Patient_first_name}}
Last name: {{form.Patient_last_name}}
Email address: {{form.Patient_email_address}}
Contact number: {{form.Patient_contact_number}}

Primary address: {{form.Patient_address}}

Signed HIPAA form: {{form.Signed_HIPAA_authorization_form}}
Signed consent to dental procedures form: {{form.Signed_consent_to_dental_procedures_form}}
Signed bill of patient rights and responsibilities: {{form.Signed_bill_of_rights_and_responsibilities}}
Documents outstanding: {{form.Additional_documents}}
Documents outstanding (other): {{form.Other_(please_specify)}}

Reason for calling: {{form.Reason_for_calling}}

New information: {{form.New_patient_information}}

All of the information collected so far in the checklist is presented above for your convenience.

Simply copy and paste it into your patient's medical CRM record.

You can have this information sent automatically when the task is checked as completed. For example, if Hubspot is your CRM of choice, you can use one of our 1,000+ app integrations.

Welcome:

Prepare welcome email

Prepare a welcome email to send to your new patient.

The goal of sending a welcome email like this one is to support your new patient's decision to go with you for their dental needs by providing them with value in the form of information or relevant content.

Below are some components you might want to include in the welcome email, presented as a sub-checklist. You may not feel the need to include all of them, but use this list as a guide to inform your own customized email targeted specifically at this new patient:

1

Introduction to you / your practice
2

Short, relevant video with contextual information
3

Digital brochure containing information about your practice
4

Content referencing you or your practice (blog posts, articles, etc.)
5

Customer testimonials
6

FAQ

Complete the form fields in this checklist by adding content to be included in the welcome email for this patient.

Welcome message

Welcome brochure (.pdf)

Send welcome email

Edit the contents of the email widget below to include only the relevant information. The information from the previous task has automatically been added for you.

Once everything looks okay, just hit the send button.

Scheduling:

Schedule intake appointment

Next, arrange a time for the initial intake appointment with your new patient.

Insert your own scheduling tool into the body of the email widget below and then hit the send button.

Confirm appointment date

Record the confirmed date in the form field below as soon as you receive a reply from the client.

Intake appointment date

Dental history:

Send oral health questionnaire

Send over an oral health questionnaire to get current information on the patient's overall dental and oral hygiene.

Include a link to your own questionnaire in the body of the email below; currently, there is a placeholder link.

Send a digital questionnaire with your survey tool of choice using one of our integrations. For example, you can use Typeform to automatically send a questionnaire when a specific task is checked as completed.

Receive completed oral health questionnaire

Once the client has filled out the oral health questionnaire, record links to the completed form in the form field below.

Preparation for appointment:

Prepare directions to clinic

Make sure your client has no trouble finding the clinic by providing them with information for locating you.

This may just be a link to a page on your website or a simple Google Maps URL; whatever the case, use the form field in this task to let your client know how to locate the clinic.

Provide directions to clinic

Use this email widget to provide detailed instructions to your patient for locating the clinic.

Request they bring additional documents to the appointment

The information you input earlier has been added to the email widget below. Check the information within it is accurate before sending the email.

Intake appointment:

Understand patient's needs

Use the form field in this task to summarize your patient's dental needs. Understand why they are coming to you for help and consider everything you've learned so far during your meetings and correspondences with them.

Summary of patient's needs

Post-appointment:

Upload proof of identification

Upload the patient's proof of identification as requested pre-meeting. This will be sent to your dentistry CRM later on.

Patient identification

Upload dental history documents

Upload the patient's dental history documents as requested pre-meeting. These will be sent to your dentistry CRM later on.

Dental history documents

Upload insurance documents

Upload the patient's insurance documents as requested pre-meeting. These will be sent to your dentistry CRM later on.

Insurance documents

Upload documents (other)

Upload any additional documents not specified. These will be sent to your dentistry CRM later on.

Documents (other)

Determine next steps

Briefly outline the next steps for your new patient. This will be sent to them in an email in the next task.

Simple instructions or information about your next meeting will be sufficient; the goal is to provide them with an indication that the process is moving forward.

The email will be presented in the following format:

It was great speaking with you the other day. Based on what we discussed, I'd like to advise you on the next steps: {{form.Next_steps}}

Use the form field below to record information about the next steps for your new patient.

Next steps

Inform patient of next steps

Simply check the contents of this email and hit the send button as soon as everything looks okay.

Update dental CRM

New patient information

Summary of patient's needs: {{form.Summary_of_patient's_needs}}

Oral health questionnaire (complete): {{form.Completed_oral_health_questionnaire}}

Proof of identification: {{form.Patient_identification}}
Dental history documents: {{form.Dental_history_documents}}
Insurance documents: {{form.Insurance_documents}}
Documents (other): {{form.Documents_(other)}}

Using the information above to update the patient's profile in your dentistry CRM.

Use one of our integrations to automatically send this information to your dentistry CRM. Check out how you can do this with Hubspot, or 1,000+ other applications.

Insurance:

Check insurance coverage

Check whether or not the patient's current insurance plan is adequate to cover all of their specific dental needs.

Simply determine the scope of their coverage and record the declaration in the form field below.

Patient covered by insurance?

Provide payment options

Inform your patient them of the different payment options available, in the event that their insurance plan does not cover treatment at your practice.

You can edit the body of the email template to include your own payment options.

Automatically send this email as soon as you've determined their coverage by setting up an email integration. MailChimp and Gmail both work great for this.