Create Patient Intake Forms

Access Intake Form Management

Log into RXNT and select Intake Form Management from Utilities.


Create a New Form

Click + Intake Form.


Enter a Name for your intake form.


Choose Form Components

Add prebuilt components to your intake form by dragging them from the Prebuilt components list to the Selected components list. Prebuilt components are for standard patient demographics and insurance fields.


Click here to see the list of available prebuilt components
  • First name
  • Middle name
  • Last name
  • Preferred name
  • Date of birth
  • Patient sex
  • Patient address
  • Preferred phone
  • Home phone
  • Cell phone
  • Work phone
  • Other phone
  • Email
  • Race
  • Ethnicity
  • Preferred language
  • SSN
  • Sexual orientation
  • Gender identity
  • Marital status
  • Employment status
  • Preferred communication method
  • Time zone
  • Emergency contact
  • Primary insurance
  • Secondary insurance

Add a custom component by entering a name or question to display for the patient. Then choose a component type and click Add.


Click here to see the list of available custom components
  • Header
  • Free text box
  • Free text area
  • Phone number
  • Date picker
  • Number
  • Radio select
  • Single select dropdown
  • Multi select dropdown
  • Address

Rearrange components by clicking on the component and dragging it to the location where you want it to appear. Remove components from the selected list by clicking x to the right of the component name.


Preview and Save

Click Preview to see how the intake form will appear to patients.


Click Modify to return to the previous screen and continue editing your form. Click Save to create the intake form.


 Intake Forms cannot be edited once they have been saved. You will be asked to confirm that you want to save the form.



Save as Draft and Finish Later

If you aren't ready to complete an intake form you're working on, you have the option to save it as a "Draft" and finish setting it up later. To save a form as a draft, click Save Draft in the create intake form page or in the intake form preview.


Draft intake forms will appear in the intake form list with a Draft tag and can be completed by clicking on the edit icon.


 Draft intake forms are considered 'incomplete' and will not be available to send to patients until they have been completed and saved from the intake form preview page.

Create a New Form from an Existing Intake Form

Navigate to the existing form in the list and click on the Duplicate icon.


In the create form screen, update the form name and make any necessary changes or additions to the form components. Then, preview and save the form as normal.


 Both active and inactive intake forms can be duplicated. The new form created this way will automatically be saved to the active intake form list.

Deactivate an Intake Form

To deactivate an intake form, and prevent it from being sent to patients, click the Deactivate icon on the active form list.


Click Deactivate on the confirmation message that appears.


The form will automatically move to the inactive list, and staff members and providers will no longer be able to send the form to patients.

  Patients who have already been sent this form, but haven't completed it yet, will still be able to complete the intake form.

Reactivate an Intake Form

To reactivate a form from the Inactive list, click the Reactivate icon on the inactive form list.


Click Activate on the confirmation message that appears.


  The form will automatically move to the active list, and the form will be available for staff and providers to send to patients.


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