Platform Capability

Intake and Consent Forms Already Built for Every Program

We've already built the intake and consent for every program — GLP-1, hormones, peptides, labs, and more — so you launch with them ready on day one. Customize anything you want, but you don't have to build a thing. Every answer flows straight into the chart and the provider's decision.

No startup fees · No long-term contracts · Live in under a day

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1M+
Patients served
<1 day
Typical setup
$0
Startup fees

The forms are done — you don't build anything

Writing a clinically sound intake is real work: the right questions for each therapy, the contraindication screens, the program-specific consent language your providers and counsel would sign off on. It's the least glamorous part of launching a telehealth program and one of the easiest to get wrong. Most platforms hand you a blank form builder and wish you luck. We did the work instead — every Heally program ships with its intake and consent already built, reviewed, and ready to turn on.

That means the day you activate GLP-1, hormones, peptides, or labs, the questionnaire and consent are already there — no drafting, no form vendor, no PDF hand-off. If you want to tweak a question, add your own, or adjust consent wording, you can; it's fully customizable. But the default is a complete, working intake, and every answer lands directly in the patient's chart where the provider reviews it. The intake, the visit, and the resulting prescription share one record.

GLP-1 intake — prebuilt, ready to use Included
Weight history & goalsRequired
Current medicationsRequired
Thyroid condition follow-upIf "yes" above
Contraindication screenFlags provider
Informed consent — compounded GLP-1Signature
Completion rate (mobile)91%

How intake works — already done for you

1
Turn on a program — its intake is already built

Every program arrives with its questionnaire, contraindication screens, and consent language prebuilt and ready. Use it as-is, or customize any field, question, or consent if you want to.

2
Patient completes it under your brand

The patient fills out intake and signs consent on your clinic's branded, mobile-friendly flow before the encounter, so nothing is gathered live that could have been captured up front.

3
Answers land in the chart

Responses flow directly into the patient's record. The provider reviews a structured intake, not a loose PDF, and consent is recorded and timestamped.

4
The provider decides with full context

The licensed provider evaluates the patient against the intake and makes every eligibility and treatment decision, then the visit and any prescription continue on the same data.

Prebuilt for every program — yours to customize

Each program ships with a complete intake built for it. Everything below is already done for you — and everything below is editable if you want to make it your own.

1
Program-specific questionnaires

A GLP-1 intake, a TRT or HRT hormone history, a peptide screen, a lab-testing questionnaire — each program gets the questions it actually needs.

2
Consent and disclosures

Capture program-appropriate consent and disclosures, including the compliance language your providers and counsel require, recorded and timestamped in the record.

3
Conditional logic

Show or skip questions based on prior answers so patients only see what's relevant — shorter forms, cleaner data, fewer drop-offs.

4
Contraindication screening

Build the screening questions that surface flags for the provider up front, so the clinical review starts from a structured safety picture.

5
Branded, mobile-first flow

The intake experience carries your clinic's name and domain and works on a phone, where most patients will actually complete it.

6
Straight into the chart

Every response and signature flows into the same record the provider, visit, and pharmacy use — no export, no re-entry, no second system.

GLP-1 intake — prebuilt, customizable Ready to use
NumberCurrent weight & goal weightRequired
MultiPrior GLP-1 use — which medication?Required
LogicIf "yes" → show titration history questionsConditional
ConsentCompounded medication disclosureSignature
Every program comes with its own intakeEdit anything, optional
Intake completion — this month Avg. 4m 12s to complete
Started
412
Questions done
338
Consents signed
313
Visit booked
288
Drop-offs get an automatic finish-intake nudge24 recovered

Security, consent records, and data ownership

Intake handles some of the most sensitive data in your clinic, so it runs inside the same HIPAA-compliant platform as the rest of the encounter — encrypted in transit and at rest, with consent captured, timestamped, and stored in the patient record. Because the form, the chart, the visit, and the prescription share one system, you get a clean audit trail from what the patient consented to through to what the provider decided, rather than a consent PDF sitting in one tool and the clinical record in another.

Ownership stays with you. Patients complete intake under your brand and domain, and the patient relationship and records are yours — Heally provides the infrastructure behind your identity. This is the difference from bolting a standalone form builder onto software-only EHR tools: a third-party form may not be covered by the same business associate agreement, and even when it is, it doesn't connect to the visit or the prescribing decision. Here, intake is native to the platform that also runs patient engagement and fulfillment.

A note on intake and clinical responsibility

Intake forms gather information and consent; they do not make clinical decisions. Screening logic surfaces information for the provider — it does not approve or deny treatment. Every eligibility, dosing, and prescribing decision rests with the licensed provider after an appropriate evaluation, and consent language should be reviewed by your providers and legal counsel. Where compounded medications are involved, they are prepared by licensed pharmacies and are not FDA-approved.

Prebuilt intake removes the biggest launch chore

Wherever a clinic runs more than one kind of care, intake is the quiet blocker — a functional-medicine practice needs profoundly different questions than a weight-loss visit, and writing all of them is what stalls a launch. Because every program on Heally already ships with its intake and consent built, that chore is gone: a clinic adding lab testing gets an intake that already captures the right history and consent for panels like DUTCH or a gut-biome test before a single sample is ordered.

Because the intake is prebuilt per program and feeds directly into the visit and everything downstream, adding a new service line is a switch you flip, not a form you build — and the context a patient provides once follows them through the entire encounter. It is all one system, included together, with no separate form-tool subscription and no startup fee.

Questions about intake and consent

Do we have to build the intake forms ourselves?+

No. Every program ships with its intake and consent already built — a GLP-1 questionnaire, a hormone history, a peptide screen, a lab-testing intake, each with its own consent language. You can use them as-is on day one, or customize any question or consent if you want to.

Do the answers flow into the chart automatically?+

Yes. Every response and signature lands directly in the patient's record — the same record the provider, visit, and pharmacy use. There is no PDF hand-off and no re-keying between systems.

Is consent captured and stored compliantly?+

Consent is captured, timestamped, and stored in the patient record inside a HIPAA-compliant platform, encrypted in transit and at rest. Your providers and legal counsel should review the consent language you use.

Can intake screen for contraindications?+

You can build screening and conditional logic that surfaces flags for the provider up front. Intake surfaces information; it does not make the clinical decision — that always rests with the licensed provider.

Whose brand do patients see when they fill it out?+

Yours. The intake flow carries your clinic's name and domain and is mobile-friendly. The patient relationship and records are yours; Heally provides the infrastructure behind your identity.

Is the form tool a separate cost?+

No. Custom intake and consent are part of the platform, bundled with the EHR, video visits, provider network, and pharmacy fulfillment — no separate form-builder subscription, no startup fees, and no long-term contracts.

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Intake for every program, already built in

Every program comes with its intake and consent ready to go — feeding straight into the chart, the visit, and fulfillment, with no separate form tool and no startup fees. Customize it to your clinic in a live walkthrough, or just turn it on.

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Included with every Heally partnership

Configurable intake and consent ship with the platform — feeding straight into the chart, the visit, and fulfillment, with no separate form tool and no startup fees. Let's design an intake for your programs in a live walkthrough.

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Schedule a demo

See how quickly you can run your whole clinic on Heally — software, a 50-state provider network, and pharmacy fulfillment, handled from day one.