In this article, you will learn how to use Barti's digital patient intake form, including how to send it to patients before their appointment, link completed forms to a Patient Profile, and view intake history from the Patient Profile or Exam.
Patient Intake Form
The patient intake form can be customized to your practice. Barti surfaces follow-up questions based on a patient's response. To request updates to your intake form, contact the Barti Implementation Team.
Question Types
Single-Line Input
Long Text
Yes/No
Dropdown
Multi-Select Dropdown
Section 1: Patient Information
* First Name*
* Preferred Name
* Date of Birth*
* Last 4 digits of Social Security Number
* Sex*
* Gender
* Pronouns
* Phone Number
* Email Address
* Address
* How did you hear about our office?*
Section 2: Purpose of Visit
* What is the reason for today's visit?*
* Is there anything you would like us to know in advance of your appointment?
Section 3: Ocular History
* Do you currently use glasses?
* How old is your current pair of glasses?
Do you currently use contact lenses?
What type of contact lenses do you use?
Are you happy with your current contacts?
Have you previously been diagnosed with any eye conditions?
Have any family members previously been diagnosed with eye conditions?
Section 4: Medical History
* Who is your primary care provider?
* Name * Number
Have you previously been diagnosed with any of the following conditions?
If Diabetic: Year of diagnosis, Diabetes Type, Last A1c, Date of last A1c
Have you ever had eye surgery or been hospitalized?
Are you currently taking any medications?
Do you have any medication or non-medication allergies?
Have any family members been diagnosed with the following conditions?
Section 5: Social History
* Do you smoke cigarettes?
* If Yes: How many packs a day and for how many years? * If Former Smoker: Years smoked
Do you drink alcohol?
If Yes: How many drinks per week?
Do you use recreational drugs?
If Yes: Please specify type and frequency.
Section 6: Additional Questions
* Primary Language
* Ethnicity
* Race
Section 7: Finalize and Submit
* I give consent for my eyecare provider's office to bill my insurance for today's visit. I understand that I will be responsible for charges not covered by my insurance company.
* I consent that exam records (including referrals, medication prescriptions, glasses/contact lens prescriptions) can be sent to me digitally by email.
* I have read and agree to the office's privacy policy.
* Today's Date
* Please enter your initials below.
Linking an Intake to a Patient Profile
To link a completed intake form to a Patient Profile:
1. Navigate to Patients > Forms to see pending intake notifications.
2. Select View Form to open the completed form.
3. If the form has not been linked, select Please link this form to a patient.
4. Search for an existing patient or create a new one.
5. Select Edit Personal Info to open the patient demographics fields, then use the copy button in the intake form to copy information directly into the Patient Profile.
Viewing the Patient Intake
There are three places to view a patient's intake:
From the Patient Profile
Navigate to Patients > Search or use the universal search bar to find the patient. In the Patient Profile, select the Forms tab to see all of the patient's intake forms.
When in the Exam, navigate to the Intake tab to view the patient's intake history.
Navigate to Patients > Forms and search for a patient to view their intake forms.
Frequently Asked Questions
Can I print the intake form?
Currently the intake cannot be printed. To view the intake during an exam, find it on the right-hand side of the Exam under Patient Details.
What do I do if the patient has not completed their intake before arrival?
You have three options: text the intake link to the patient so they can complete it on their smartphone; hand the patient a tablet in the office to complete the form; or have a staff member complete the intake audibly with the patient and have them sign a paper policy form.
If you have any questions, please refer to Barti's Help Center or create a support ticket at support.barti.com.