Healthcare
Patient intake
Take the history the evening before, so the first minute of the appointment is about the patient.
Why this survey gets sent
“Every first appointment starts the same way: ten minutes of me typing while the patient recites medicines they half remember. By the time we reach why they came, the room is already behind.”
The same questions answered at home, with the medicine boxes on the table, come back more accurate and cost the visit nothing. The clinician reads them two minutes before the door opens, and the appointment starts at the second question instead of the first.
What is in it
- Name, date of birth, mobile number (required)
- What brings you in today, and how long you have had it
- Medicines you are taking now — or “none” (required)
- Allergies to medicine, food or material — or “none” (required)
- Conditions you have been diagnosed with (multiple response)
- Past surgery or hospital stays (long answer)
- Who to call in an emergency, and on which number
- Consent to examination and treatment (yes / no)
About 7 min to answer
Patient intake
About 7 min
How to write this survey
The history belongs before the room, not inside it
Ten minutes of a first consultation go on questions whose answers never change, asked while the patient is anxious and the clinician is typing. Sent as a link the day before, those same questions are answered at home with the medicine boxes on the table, by somebody who can read the name on the label instead of guessing at it.
It also changes what the clinician walks in knowing. A history read two minutes before the door opens turns the opening line from “what brings you here?” into “tell me about the pain you described” — and that is a difference the patient notices and remembers for longer than the visit.
Two answers must never come back empty
Allergies and current medicines are the two things a clinician may act on before reading anything else, and a blank there is ambiguous in the worst possible way: it might mean none, or it might mean the patient stopped filling the page in. Make both required, and put the honest escape inside the question — list them, or write “none” — so the blank disappears and the meaning does not.
Chronic conditions are the opposite case. Written into an open box they come back as “sugar”, “pressure”, “something with the heart” and three spellings of the same word; offered as tick boxes with a “none of these” at the end they come back countable — and the open question about past surgery that follows still catches what no list can hold.
Write it in the words the patient uses
Intake questions written out of the chart carry the clinician's vocabulary — hypertension, dyslipidaemia, comorbidities — and a patient who does not recognise a word either skips it or, worse, guesses. “High blood pressure” costs nothing to write and is understood by everyone who has it, which is the only readership this page has.
In Arabic this matters twice over, because the written term and the spoken one often part company. Write the standard term, and put the everyday word beside it wherever the two diverge; a patient who reads a name they use at home answers in one pass, and the record still carries the term the clinic files under.
Collect only what somebody will read
An intake page is the most sensitive thing most clinics collect, and the safest way to hold a detail is never to have asked for it. Go down the list and strike anything nobody reads during the visit: an identity number the reception desk copies from a card anyway, an employer, a marital status no one will use, a full address when the thing you actually reach people on is a phone.
Then write one sentence at the top saying who reads the answers and how long they are kept, in the same language as the questions. Patients answer a sensitive question far more completely when the page has already told them where the answer goes — and that sentence costs nothing except the work of making it true.
Consent is a question, and its answer is a record
End with the consent question rather than a line of small print. An answer with a date and a name beside it is a record the clinic can produce; a paragraph at the foot of a page is a hope that somebody read it. Word it as the patient's decision — do you consent to being examined and treated — and treat a no as information: it is a conversation the front desk should have before the appointment, not a failed submission.
For a patient who is coming back, do not send the whole page again. Send it once a year, or when something has changed, and ask the short version at the desk — have your medicines changed since your last visit? An intake page answered four times becomes a page answered without being read, which is worse than not asking at all.