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Bilingual Patient Intake Pack

Health Care line

Six patient forms in English and Spanish with the same layout and question order: registration, medical history, consent to treat, privacy notice acknowledgment, financial and appointment policy, and authorization to release records. Patients fill the PDF on any screen or on paper; your staff edits the Word files.

Word files and fillable PDFs, English and Spanish

Fare

$29

founding price until January 31, 2027 · then $47

Secure checkout by Stripe, which adds sales tax where it applies. You download the file as soon as you pay.

Not what you needed? Write to us within 30 days of purchase and we refund you in full.

Patient-Intake-Pack.zipSCREENSHOTS · full version
Bilingual Patient Intake Pack: Page 1, with EXAMPLE data
Page 1: a page of the full version See the whole tab
Bilingual Patient Intake Pack: Page 2, with EXAMPLE data
Page 2: a page of the full version See the whole tab
Bilingual Patient Intake Pack: Page 3, with EXAMPLE data
Page 3: a page of the full version See the whole tab

Screenshots of the full version, taken from the real file. Every number in them is an EXAMPLE.

What you do, what the sheet does

YOUTHE SHEET
You type your practice name once in the PDFIt fills the top of all six forms
A patient picks SpanishEvery form reads the same in Spanish, in the same order
A patient checks the text consent lineYou have written consent for appointment texts
You fill the policy blanks onceEvery patient signs your fees and notice hours

What the full version has

  • New Patient Registration with insurance, language and consent to text
  • Medical History with medicines, allergies, conditions and family history
  • Consent to Treat with an optional telehealth line
  • Acknowledgment of Notice of Privacy Practices with contact preferences
  • Financial and Appointment Policy with blanks for your fees
  • Authorization to Release Health Information with every HIPAA element
  • A setup guide with a link to the HHS model Notice of Privacy Practices

Who it is for

Small clinics, dental and therapy practices and home health agencies in Texas that see Spanish speaking patients and want one set of forms in both languages.

Have your attorney or compliance advisor review these forms before you use them.

Made by BuiltByEstrada in McAllen, Texas. In English and Spanish.