Electronic Forms Available In Healthie

Healthie's templated intake and charting forms can be found in your Forms Library. Depending on the specialty that you indicated when signing up for Healthie, you may also see industry-specific forms for your use (see Speciality Forms). 

Forms Library: Overview

Healthie provisions you with a library of templated forms and charting notes, as well as the ability to build your own forms. 

If you have existing practice forms or charting templates that you would like added to Healthie, our team can help accommodate this request. Learn more: Request Healthie Add a Form to Your Account

We recommend consulting with an attorney and/or insurance companies that you work with, to confirm that intake forms and charting templates, as well as disclaimers that are available through the platform, are acceptable for your use.

Standard Forms Not Visible in the Forms Library 

Some of the available forms will not appear in your Form's Library, which indicates that they are a fixed-form and cannot be edited. 

Forms that are automatically added to your account, but not visible in the forms library include: 

• Billing Info form (to collect a credit card on file) 
• Insurance information form (to collect insurance details & a copy of the insurance card), and the 
• Photo ID form (to collect a copy of the client's ID such as a license). 

To view forms that do not appear in your Forms, we suggest that you add them to an intake flow and "Preview" the flow. This will walk you through your client's experience with your electronic paperwork. 

Client Information Forms

Billing info

Request a client's card information be securely kept on file. This is useful to charge no-show fees/cancellation fees, as well as purchase packages for clients on behalf of them. 

This form is not visible in the Forms Library, and cannot be edited directly.  

More information: Billing Info Form

Insurance info

Request that a client enter their insurance information - you can use this for an eligibility check, and information will auto-fill into any CMS-1500 forms you'd like to generate in the future.

This form is not visible in the Forms Library, and cannot be edited directly.  

More information on insurance information here.

Photo ID 

Collect a copy of your client's identification, such as a valid driver's license. 

This form is not visible in the Forms Library, and cannot be edited directly.  

Learn more here. 

Client Profile Picture 

Have a client add a profile picture, which they can upload directly from their computer. Learn more about picture sizing requirements and supported file types here. 

This form is not visible in the Forms Library, and cannot be edited directly.  

Incident Report 

Need to document a reported client incident? Leverage this form to collect client information, data of incident, and incident details.

Practice Policy Forms & Waivers

HIPAA Privacy Policy (English & Spanish)

A HIPAA Privacy Policy informs clients as to how you protect their information and assures them that you won’t be sharing their information without their explicit approval. 

If you would like to upload your own version of a HIPAA Privacy Policy or modify the existing HIPAA form, you can create a new agreement. 

A version of this form is also available in Spanish. Learn more. 

Financial Agreement

An agreement that its the client’s responsibility to check insurance benefits and coverage. If their insurance does not cover, the client is responsible for any non-covered services, deductibles, co-payments or co-insurance, as determined by their insurance carrier.

Cancellation Policy

An agreement for your clients to sign understanding your office policies which include charges for no-show fees/cancellations.

Client Testimonial Waiver & Testimonial Release 

Collect a testimonial from your client, and obtain their permission for you to use their testimonial in your marketing. 

Physician Authorization of Release

Clients can enter the name and contact information of other providers that they are working with. They can then approve that you share charting notes and results with these providers.

Release of Information

This form gives permission to communicate with the client's other healthcare provider so that you can exchange charting notes, laboratory values, etc. 

Covid-19 Screening Form 

Screen for any clients that may have been exposed to COVID prior to your in-person consultation. 

Advanced Beneficiary Notice (ABN) Form

Also known as a waiver of liability, an ABN is a notice provider should give to clients before they receive a service if, based on Medicare coverage rules, you believe Medicare will not pay for the service.

Client Exit Survey

Utilize this form to collect important information from your client upon ending care.

Assessment & Charting Forms 

Healthie hosts several assessment and charting note templates that can be customized. Use the charting forms as-is, or adjust them to fit your practice needs. Doing so can help reduce time on charting, and improve your workflows. Healthie chart notes can also be shared with clients, other team members, and external care-team members (all in a HIPAA-compliant manner). 

Healthie Smart Form (English & Spanish)

Collect basic client information like Name & Address, Phone Number, and Health history. Information from the Healthie Smart Form automatically pre-fills into other parts of your platform, like the client profile. This basic intake form includes the most common questions asked by health and wellness providers. 

A version of this form is also available in Spanish. Learn more. 

New Patient Assessment

A questionnaire that asks for an overall view of the client's general lifestyle and health habits.

Health History

A general questionnaire, similar to the Healthie Smart Form that goes more in-depth on the client's health history. Information that is asked such as Name & Address and Phone Number, will automatically pre-fills into the client's profile. 

Eating Disorder (ED) Assessment Form 

Utilize this assessment form designed specifically for working with clients that have an eating disorder. Obtain relevant information when working with this patient population. 

SOAP Note 

In modern clinical practice, wellness providers share medical information primarily via written progress notes, which include histories, physicals and SOAP notes. SOAP—or subjective, objective, assessment and plan—notes allow clinicians to document continuing patient encounters in a structured way.

ADIME Note

ADIME, or Assessment, Diagnosis, Intervention, and Monitoring/Evaluation, is a process used to ensure high quality nutrition care to patients and clients from nutrition professionals, such as Registered Dietitians. 

PES Statement 

A  PES statement (or Nutrition Diagnosis Statement) is a structured sentence that describes the specific nutrition problem that you (the dietitian) is responsible for treating and working toward resolving, the cause/s of the problem and the evidence that this problem exists

Telehealth Forms

Telehealth Informed Consent

An agreement that explains the benefits and risks of a telehealth consultation that Informs clients of their rights when receiving telemedicine, including the right to suspend or refuse treatment.

Group Telehealth Informed Consent

An agreement that explains to the client that they will be able to see, listen to, and/or speak with their provider they are working alongside other people who may be present in the session. Anything said between any two or more group members at any time is part of the group and is confidential. 

Nutrition Specialty Forms

Consent for Nutritional Services

An agreement that the client is aware that nutrition is not an exact science and that no guarantees have been made as a result of interventions. 

Nutritional Supplement Informed Consent

An all in one contract that consists of Informed Consent/Medical Disclaimer/Office Policies. 

Health Coach Specialty Forms 

Liability Waiver for Health Coaching 

Waive liability for parties involved in a dispute, contract or other legal matters, with language tailored for health coaching. 

Physical Therapy Specialty Forms 

A library of forms specifically designed for physical therapy practice can be access here. 

Email us hello@gethealthie.com to have these forms shared with your account if you do not automatically see them.

Chiropractor Specialty Forms

A library of forms specifically designed for chiropractic practice is available within Healthie. These forms include chiropractor assessment, Terms of Acceptance & Informed Consent, note of privacy, financial policy, and a Standard Arbitration Agreement. 

Email us hello@gethealthie.com to have these forms shared with your account if you do not automatically see them. 

Behavioral & Mental Health Specialty Forms

Leverage these behavioral health specific forms to build treatment programs and set functional goals individualized to their patients current condition. Learn more here. 

• Progress Note Behavioral Health
• Behavioral Health Treatment Plan
• SOAP Behavioral Health
• Simple Progress Note for Behavioral Health
• Mental Status Evaluation Form
• Charting Template Behavioral Health
• Patient Health Questionnaire 9 (PHQ-9)
• General Anxiety Disorder 7 (GAD-7)

Coaching Program Forms

Healthie has partnerships with many coaching academies, graduate schools, and accreditation services, whose graduates use the platform to run their businesses and build relationships with clients. As part of these affiliations, Healthie makes it easy for you to access recommended forms from these coaching programs, which allows clients to fill out these forms online. Access these forms here.