Clinic template
A Cliniko patient intake form template for allied health clinics
This intake form is built as a Cliniko patient form template, not a treatment note, so it reaches patients online before their first visit and answers file straight to their record. Funding type is asked early, with Medicare, DVA, NDIS and WorkCover questions in labelled sections, since Cliniko forms do not hide sections based on an earlier answer.
Last checked 25 Sep 2026 against the sources listed at the end of this page.
Free template ยท Cliniko
Patient form: intake: allied health (general)
The template: 16 fields
| Section | Field | Type | Notes |
|---|---|---|---|
| Patient details | Full name, date of birth, contact details | Text | Cliniko calls these connected questions: when the patient submits the form, matching fields update automatically in their patient record rather than sitting only in the form response. |
| Patient details | Emergency contact name and phone | Text | |
| Patient details | GP name and practice | Text | |
| Funding type | How is this appointment being paid for | Radio | Cliniko type: Multiple choice. Options: Medicare (GP referral) / DVA / NDIS / WorkCover or CTP / Private health fund / Self funded. Ask this before the funding specific sections below, since every section still displays regardless of the answer. |
| Funding type | Medicare: GP referral and plan type attached | Radio | Options: GP Management Plan (Chronic Disease Management) / Enhanced Primary Care / Not applicable. Instruct patients in the section heading to skip this if they answered anything other than Medicare above. |
| Funding type | DVA: Gold Card or White Card, and card number | Text | Instruct patients to skip if not applicable. |
| Funding type | NDIS: participant number and plan manager | Text | Instruct patients to skip if not applicable. |
| Funding type | WorkCover or CTP: claim number and insurer | Text | Instruct patients to skip if not applicable. |
| Medical history | Current medical conditions | Paragraph | |
| Medical history | Current medications | Paragraph | Include anticoagulants and steroids. |
| Medical history | Allergies | Paragraph | |
| Medical history | Previous surgery relevant to this visit | Paragraph | |
| Medical history | Pregnancy (if relevant to the discipline) | Radio | Options: Not applicable / Yes / No. Include only where relevant to the clinic's discipline. |
| Consent and privacy | Privacy policy and telehealth consent | Checkboxes | Options: I have read the clinic's privacy policy / I consent to telehealth where offered / I consent to appointment reminders by SMS and email. |
| Consent and privacy | Cancellation policy acknowledged | Checkboxes | Options: I have read and accept the clinic's cancellation policy. |
| Consent and privacy | Signature | Text | Cliniko patient forms capture a typed or drawn signature depending on how the form is completed; check the current options in your account before building this field. |
Build it in Cliniko
- Go to Settings > Patient form templates as an Administrator, click Add template and name it Patient intake form.
- Build the Patient details section using connected questions where Cliniko offers them, for example name, date of birth and contact details, so a completed form updates the patient record automatically rather than sitting as a separate response to copy in by hand.
- Put the funding type question at the top of its own section, then add one short sub section per funding type directly underneath, each headed with an instruction such as Skip this section if you selected a different funding type above. Cliniko's patient forms do not support conditional logic that shows or hides a question based on an earlier answer, so this instruction based approach is the workaround, not a native feature.
- Mark the template as viewable by Practitioners and Administrators only if it will carry sensitive medical history.
- Add the form as a placeholder in your appointment confirmation and reminder emails so new patients receive it automatically before their first visit, and keep the one-off send option for existing patients who need to redo it.
- Test the whole form as a patient would see it, submit a test response, and check every connected field lands in the right place on the test patient's record before turning it on for new bookings.
AHPRA: The shared Code of conduct for registered health practitioners expects a patient's relevant medical history and consent to be recorded before treatment starts. An intake form completed before the first visit gives the practitioner that information in advance, but it does not replace confirming and updating it verbally at the appointment itself.
A patient form, not a treatment note
Every other template in this cluster is a treatment note, filled in by the practitioner during or after a session. An intake form is a different Cliniko feature entirely: a patient form template, built under Settings > Patient form templates, filled in by the patient themselves before they ever see a clinician, and submitted securely online. Getting this distinction right matters because the two features are configured in different places and behave differently, particularly around how questions can automatically update the patient's own record.
Funding type sits up front because Cliniko forms cannot branch
The brief for this page asked for funding type branching, so patients only see the Medicare, DVA, NDIS or WorkCover questions relevant to them. Cliniko's own patient forms do not support conditional logic that hides or shows a question based on an earlier answer, so true branching is not something the native form builder can do. This template handles that honestly: the funding type question comes first, and every funding specific section below carries an explicit instruction to skip it if it does not apply, rather than pretending Cliniko will hide it for the patient automatically. A clinic that wants real conditional branching needs a third party add-on built for Cliniko, which is a separate decision outside what this free template covers.
Connected questions are what make an intake form worth building
The reason to build an intake form at all, rather than just asking these questions verbally, is that Cliniko's connected questions update the patient's own record automatically when the form is submitted. Details like name, date of birth and contact information only need to be typed once by the patient rather than transcribed by reception staff, which is both faster and removes a step where a phone number or spelling can be typed incorrectly.
Sources
- Cliniko patient form templates are created under Settings > Patient form templates, are built from sections and questions, can include connected questions that update the patient's own record automatically when the form is submitted, and can be restricted to viewing by Practitioners and Administrators only. Cliniko Help, checked 25 Sep 2026.
- Cliniko allows a link to patient forms to be included in appointment confirmation and reminder emails, and forms can also be sent to an individual patient as a one-off outside that automated flow. Cliniko Help, checked 25 Sep 2026.
- Cliniko's native patient forms do not offer conditional visibility of questions based on an earlier answer, unlike some third party add-ons built specifically to extend Cliniko's own form builder. Finger-Ink (Cliniko-focused patient form add-on, comparing its own feature set to Cliniko's native forms), checked 25 Sep 2026.
- The shared Code of conduct for registered health practitioners, applied by each National Board including the Physiotherapy Board of Australia, expects practitioners to obtain and record a patient's relevant history and consent before treatment. Physiotherapy Board of Australia, checked 25 Sep 2026.