Details, what they'd like to book, payment and the days that suit, across three short pages. It asks returning patients when they were last in, and asks about pain only when someone has a problem with a tooth. On Pro, anyone in pain goes to a separate ending that asks them to phone, so they aren't left waiting for a callback.
Dental practices taking on new patients, from general practices to cosmetic clinics.
Medical and dental history stay out of the form, for the dentist to go through at the first visit.
Every question in this template
The pages as a respondent meets them. Pick any question to open it in the live preview above.
- Page 1Questions6 questions
- Page 2Your visit4 questions
- Page 3Booking3 questions
- ThenThank you
We'll call within a working day to book you in.
Conditional logic is already set up
Every answer, in one place
Each response lands in your inbox as a card like this one, with an email to you if you want it. People who stop part-way are kept too, with the answers they gave.
- Partial answers and drop-off by question, on every plan
- CSV, JSON and PDF on every plan, Excel on Pro
- Sheets, Slack, Notion, Airtable, HubSpot and webhooks on Pro
Maya OkaforDental new patient form · just nowNew- Your name
- Maya Okafor
- Your date of birth
- 12 March 2027
- Your email
- maya@northstar.co
- Your phone number
- +44 20 7946 0321
- Have you been to our practice before?
- Yes
- Roughly when were you last here?
- Their answer, in their own words
and 7 more answers
Three steps, a couple of minutes
- Use this template1Make it your own copyIt becomes a draft in your account. Nothing you change touches the original.
- Reword, reorder, re-theme2Change anythingQuestions, pages, logic, theme and logo. It is an ordinary form from here on.
- formkit.app/you/dental-new-patient3Publish and shareYour own link, a QR code or an embed. Every answer lands in one inbox.
What this form can also do
Questions about this template
Can I use it for medical history or health records?
No. Formkit isn't built for medical or health records and doesn't offer HIPAA compliance, so this template stays at the front desk: details, the general reason for a visit and booking. Your practitioner goes through the rest in person.
What happens when someone is in pain?
On Pro, an ending tells them to phone your emergency line, and their details are saved either way. On Free, the question is still asked, so you'll see it in their response.
Can patients sign the policies?
Yes. The signature question lets them sign with a finger or a mouse, and it's kept with their response.