Intake Forms with E-Signatures for Acupuncturists

Make first visits feel calm, professional, and easy.

With digital intake forms, your acupuncture practice can collect client details, health history, consent, and signatures in one smooth flow. Clients can complete forms before they arrive, and once a signature is added, the form becomes digitally signed, timestamped, and uneditable, with a PDF copy available to download

A better intake experience for you and your clients

Paperwork is nobody’s favorite pre-treatment ritual.

Digital forms help you create a cleaner, more welcoming experience from the very first interaction. Breely forms can be used to collect information on their own or combined with appointment booking, so your intake process can fit the way your practice actually runs

Helpful for:

• New patient intake
• Health history collection
• Consent and policy acknowledgment
• Treatment preference questions
• Follow-up forms
• Booking plus intake in one form

Build forms that fit your practice

Every form is organized into sections and questions, with a final thank-you page at the end You can add required fields, reorder questions, and preview the form before sharing it

That means you can create an intake flow that feels thoughtful instead of overwhelming.

You might include questions for:

• Contact details
• Emergency contact information
• Current concerns and goals
• Medications and medical history
• Prior acupuncture experience
• Consent to treatment
• Signature at the end

Breely also supports conditional logic, so different questions or sections can appear based on previous answers Nice touch, right? Very tiny clipboard-free magic.

Collect signatures with confidence

If your intake process includes consent, the Signature question lets clients sign or type their name directly on the form

Once submitted:

• The form is digitally signed
• A timestamp is applied
• The completed form becomes uneditable
• A PDF copy of the signed form can be downloaded

You can also add an Agree to Terms field for required acknowledgments such as cancellation policies or informed consent language

Make intake easier for returning clients

For repeat visits, a smoother process goes a long way.

Breely includes a client login option that can let returning clients pre-fill forms with information they’ve already submitted before That means less repeated typing, fewer admin follow-ups, and a better experience for everyone.

You can also use automations after form submission to send emails or text messages, reminders, and follow-up communication based on the form or appointment status

Share forms wherever clients already find you

Once your form is ready, you can share it with a direct link or embed it on your website, including as a pop-up if that fits your setup better

That gives you flexibility to use intake forms:

• On your website
• In appointment confirmation emails
• In text follow-ups
• From your social media profile
• As part of a private internal workflow

If you want, your intake form can also work alongside appointment scheduling so clients can book and complete intake details in one place

Ready to make intake easier for your acupuncture practice? Create a form that collects the right details, captures e-signatures, and gives clients a smooth start before they even walk through the door.