Dental New Patient Registration Form

Streamline dental procedures when registering new patients with our free mobile patient form.

New patients can quickly provide your dental staff with the required information when visiting the office for the first time. Free up administrative resources by gathering the basic dental information right on mobile devices.

Try our dental new patient registration form for free on any mobile device with a free trial of IntouchCheck mobile form software. Sign up for a free trial today and ask your Intouch specialist to load this pre-built form into your account.

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Why you'll love mobile forms

  • Eliminate paper work
  • Get analytics on form results
  • Access & send detailed PDFs from anywhere

An influx of new patients who need dental records made for them before receiving services can put a strain on your dental staff. You need to have these patients registered while still providing quality dental care to existing customers. The new patient registration form is designed for dental offices so you can gather the patient's information right on desktops, tablets, or mobile devices so accurate dental records can be made.

Form Details

The dental new patient registration form template is simple to use as your patients can fill out the form while in the waiting room. Gather their contact information, insurance information and other necessary health and dental details directly on the form that can be used on any mobile device such as a smartphone, tablet, iPhone or iPad. Your dental staff can continue working with existing patients to provide quality care, and then easily place the new patient registration form information into their computer records quickly.

Cut down on wait times and free up your staff resources with this form template. Our mobile form includes the following categories:

  • Basic patient info
  • Patient relationship status/employment
  • Patient contact information
  • Emergency Contact information
  • Parent/Guardian Information (only populates if applicable)
  • Patient insurance information
  • Financial responsibility acceptance verifications
  • Patient signature

Customize Your Digital Dental New Patient Registration Form

We know that every business is unique, and your forms should reflect that. Our ready-to-use template is a comprehensive list of industry standard fields, but it is most useful when customized to reflect your own needs. The IntouchCheck platform makes it simple to quickly customize the mobile form template to meet the individual needs of your company and goals; questions, fields, or sections can be quickly removed, and new queries or fields can be added in the appropriate places to fit your project.

Create Your Own Dental New Patient Registration Form Template

Already have processes and procedures in place? IntouchCheck’s straightforward interface makes it fast and easy to create your own forms, where you can customize the sections, categories, questions, and types of data/image capture fields. We’re here to help you get started! Try IntouchCheck for free, and see how easy it is to streamline your business processes.