Intake Forms with E-Signatures for Chiropractors

Make first visits feel easier—for you and for your patients.

With online intake forms, chiropractic practices can collect patient details, guide people through the right questions, and capture digital signatures before the appointment even begins. Breely forms support flexible question types, conditional logic, appointment booking, and a built-in signature field that makes the form digitally signed, timestamped, and uneditable once completed. Signed forms can also be downloaded as PDFs

Help Patients Complete Intake Before They Walk In

A smoother check-in starts with a smarter form.

Use online intake forms to gather the information your practice needs ahead of time, such as:

• Contact details
• Phone number and email
• Health history and background notes
• Important dates
• Uploaded documents or images
• Required agreements and consent

Breely forms are built in sections, so information stays organized and easy to complete. You can also mark questions as required to make sure nothing important gets skipped

Add Digital Signatures Without the Paper Shuffle

No printer. No clipboard. No mystery handwriting.

Breely includes a signature question type that lets clients sign or type their name directly on the form. Once a signature is added, the form becomes:

• Digitally signed
• Timestamped
• Uneditable

You can also download a PDF copy of the signed form when needed, which is especially helpful for consent forms, office policies, and patient acknowledgments

Personalize the Form for New and Returning Patients

Not every patient needs the exact same intake experience.

Breely supports conditional logic, so your form can change based on a patient’s answers. For example, you can show different follow-up questions for new patients, injury-related visits, or people returning for ongoing care. If clients log in, previously submitted information can also pre-fill future forms, which helps save time and reduce repeat typing

You can also customize the look of your form with:

• Your logo
• Brand colors
• Fonts
• Background styling

That means your intake flow can feel like part of your practice—not a random third-party page floating in space

Connect Intake with Booking and Follow-Up

Intake works even better when it plays nicely with scheduling.

Breely forms can be used as standalone forms or combined with appointment booking. After submission, you can trigger automations like email or SMS messages, appointment reminders, and other follow-up communications based on form activity or appointment status

That helps chiropractic practices:

• Reduce back-and-forth before appointments
• Keep front-desk work lighter
• Send reminders automatically
• Create a more polished patient experience

Share Forms Wherever Patients Need Them

Keep access simple and convenient.

You can share Breely forms with a direct link or embed them on your website. If you prefer, you can also launch them in a pop-up. Forms are private by default, which means they are only accessible to people with the link unless you intentionally place them on your site

Whether you want a new patient intake page, a consent form before treatment, or a streamlined booking-and-intake flow, you can build the experience around how your practice actually works.

Ready to give patients an easier start and your team less paperwork? Create your chiropractic intake form with e-signatures and make every first impression feel a little more aligned.