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Essential Patient Forms for Private Wellness Practitioners

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One of the first, and most important, steps to building a private practice is to create your new patient intake forms. Essentially, this paperwork consists of the policies and agreements that you would like each new patient to complete prior to working together. Many providers feel like they can’t launch their practice until they have their intake forms finalized. Intake form are essential: they protect your nutrition practice by collecting signed policies and forms from patients that outline expectations, legal practices and financial agreements. Operating without these necessary intake forms puts your business at risk, both financially and legally.

Today we’re breaking down this barrier to launching by outlining which intake forms you really need for your new wellness practice. Plus, we’re sharing expert tips on how you can streamline the patient form completion process.

Note: we are sharing general advice and always urge you to review any intake paperwork with a business attorney and/or business. accountant.

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Here’s Our List of Top Patient Forms for Wellness Practices:

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New Client Intake Forms

Basic Information: Collect patient information like name and address, phone numbers, emergency contacts, and more.

Nutrition Assessment Form: A basic nutrition assessment form collects general nutrition information. For example, your patient’s reasons to visit with you, their nutrition goals, and nutrition history. This form can be as detailed as you like. Over the years we’ve learned, no 2 intake forms are the same!

  • Some providers have their patients fill out an intake form in advance of their first appointment, while others prefer to complete this form with their patient.
  • Ask us about Healthie’s Smart Form available for Healthie community members to use in their practice.

HIPAA Privacy Notice: Protecting your patient’s private health information is critical. This is why we recommend you have a HIPAA Privacy Notice. This form details how you protect their information and assures patients that you won’t share their information without their explicit approval.

    • You can download our sample HIPAA Privacy Notice here.

Charting Templates: ADIME, SOAP notes, or free-text notes are all acceptable charting methods. Charting helps you document your nutrition care plan.

  • ADIME and SOAP notes are a part of the dietitian Nutrition Care Process, and provide an organized format to Assess, Diagnose, Intervene, Monitor, and Evaluate your patients for ongoing care.

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Office Policies

Cancellation Policy: Establishing a cancellation policy isn’t fun. For many health and wellness providers, however, it’s important. We’ve seen a variety of cancellation policies. Some practitioners charge a small fee for cancellations within 24 hours, while others request the full appointment fee. Whichever way you decide is most appropriate for your practice, be sure to have this discussion with your patient early on in your relationship.

Statement of Financial Responsibility: It’s important to secure a method of payment from every patient. Having a patient sign this statement ensures they are responsible for paying for services rendered. This policy form should be unique to your wellness practice. Some important considerations you may want to include in your financial agreement paperwork:

  • Forms of payment accepted (ie. cash, check, credit cards, HSA/FSA cards, insurance, online payment processor)
  • Payment terms (ie. when payment is expected, if you offer payment plans)
  • Policies on declined payments (ie. declined credit cards, bounced checks)
  • How you keep your client’s financial information secure
  • Refunds policy
  • No show and late cancellation policies
  • Client responsibility when using insurance (ie. copays and charges for remaining client responsibility or denied insurance claims)

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Client Referral Forms

PCP Referral Form: Insurance companies often require a referral from a primary care physician as part of your treatment. If this is the case, having the patient’s primary care physician (PCP) complete your referral form can streamline the reimbursement process.

Information Release Authentication: An information release form details the individuals with whom you can speak to regarding patient information. This is especially useful when you’re working as part of a care team with other health providers. Typically, this includes other doctors, nurses, and behavioral specialists, but in some cases could include a patient’s family or guardians.

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Insurance-Based Client Forms

Insurance Information (optional): If you take insurance, find out your patient’s insurance information early on in your conversations. This way, you’ll know what services are covered. Plus, you’ll have their information on file.

Superbill: If you don’t bill to insurance, or request that your patients submit claims directly to their insurance provider, you can provide a Superbill. We generally recommend preparing it immediately following a patient appointment.

PCP Follow-up form: If another provider referred a patient, sending a follow-up note to summarize your visit is a good idea. Typically, this is a modified version of your chart note, with additional summary information.

Pro-tip: Good and timely communication is a great way to build strong relationships with referring providers.

It is always necessary to keep signed and completed patient intake forms on file for legal purposes. Generally, when working with insurance companies, it’s required to store patient charting and information for 9+ years. Having paper copies or storing patient information locally on a non-secure computer opens up your practice to risk and liability.

Using an EHR platform is a useful solution to both securely store patient paperwork, complete chart notes and to streamline the intake form process. With Healthie, a practice management platform for dietitians, you can create your new patient intake forms and will automatically distribute them to patients to complete electronically. The completed intake forms are automatically stored within your Healthie provider account, and can be accessed from any computer using your secure login.

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