A podiatry new patient intake form that asks about the shoes

In podiatry, the cause of the problem walks in wearing it

A podiatry new patient intake form has one job a general medical intake never manages: finding out what the patient does on their feet all day, and what they do it in. Most templates you can download are a symptom list with a medication box, which is fine for a specialty where the problem is internal. Podiatry is not that specialty. The shoes a patient wears for a ten-hour shift, the surface they stand on, the inserts already sitting in the closet and who has been cutting their toenails explain more of what is in front of you than almost anything else on the page — and none of it gets answered honestly on a clipboard five minutes before the appointment, because the shoes are at home. This preset asks those questions properly, in language a patient can answer at the kitchen table the night before. Every field is editable, the printable PDF is ready as soon as the page loads, and there is no signup or email wall.

• Built for HIPAA-compliant workflows

• Free to start — 50 patient actions each month

What a podiatry new patient intake form usually covers

The administrative layer first: contact details, date of birth, emergency contact, insurance where your workflow includes it, referral source, primary care provider and pharmacy. Then the reason for the visit in the patient's own words, with which foot, whereabouts on it, how long it has been going on and what makes it better or worse. Then the general medical background that shapes a podiatry plan more than it shapes most others: diabetes and how long, circulation or blood pressure problems, arthritis, numbness or neuropathy the patient has been told about, previous foot or ankle surgery and fractures, current medications including blood thinners, and allergies. Then the podiatry-specific block — footwear, standing hours, work surface, sport and mileage, existing orthotics or over-the-counter inserts, and the current nail and skin care routine. Finally, what the patient wants out of the visit, which for a marathon runner and for someone who cannot get a shoe on are two entirely different answers. Practices handing out a stack of podiatry new patient forms at the front desk usually collapse the lot into this one document.

Footwear, hours and the inserts already in the closet

This is the block worth building the form around. Ask what shoes the patient wears for work and how many hours a day they are on their feet, and on what surface — a concrete warehouse floor and a carpeted office produce different feet. Ask about sport and roughly what mileage, because a runner's answer reframes everything above it. Ask about existing orthotics and inserts as repeating rows: custom or over the counter, roughly when they were made, by whom, and whether the patient still wears them, since a drawer full of abandoned inserts is a history in itself. Ask who currently trims the toenails, which sounds trivial right up until the patient is diabetic or cannot reach their own feet. And then use the form for the thing no static PDF in the search results can do: add a line asking the patient to bring the pair of shoes they wear most to the appointment. It costs one sentence of helper text, and it changes what happens in the room, because the wear pattern on a worn sole says things the patient cannot.

Edit it in plain language, download exactly what you built

Rename the form, rewrite any question or helper line, mark fields required or optional, and add, duplicate, reorder or remove whole sections. A practice built around diabetic foot care, a sports clinic and a routine nail-and-skin caseload want noticeably different things from the same starting point, and none of them should have to accept a fixed document to get any of it. Increase the number of orthotic rows. Drop the sport questions if nobody asks them. Rewrite the footwear question in the words your patients actually use. Treat it as a podiatry intake form starting point rather than a finished document, because that is what it is designed to be. A default PDF is available the moment the page loads, and after any change a new PDF is generated from your current version, so the packet you print or email is the one you built rather than the original preset. It prints on US Letter with clean page breaks and enough writing space that a patient can give you a real answer instead of one word squeezed into a box.

A two-podiatrist practice in a town that works on its feet

Take a two-podiatrist practice in a town of warehouses and one large hospital, where most new patients spend their working day standing. They start from this preset and spend half an hour on it. The footwear and standing-hours questions become required, and the helper text underneath asks the patient to bring the shoes they wear most — a line the front desk now repeats when it confirms the appointment. The orthotics section goes from one line to four rows, because patients kept arriving with a bag of old inserts and no idea where any of them came from. They add a plain question about who cuts the patient's toenails, which the lead podiatrist now reads first for anyone who has ticked diabetes. And they leave out the diabetic foot risk category a colleague suggested printing at the top, because that gets assigned in the room, not on a form filled in at a kitchen table. Same appointment length as before, and patients now walk in carrying the evidence.

Reported by the patient, examined by the podiatrist

Everything on this form is written by the patient and recorded exactly as given. Nobody at the practice completes it on the patient's behalf, and none of it is a clinical finding — it is the patient's own account, gathered before the visit rather than reconstructed during it. The form carries out no examination of any kind. It does not check pulses, test sensation, assess circulation, look at a wound, or produce a diabetic foot risk category, a neuropathy screen or any other classification. It offers no diagnosis and no treatment plan. All of that belongs to a licensed podiatrist with the patient's foot in front of them, and this document simply makes sure that appointment starts with the history already written down. On privacy: this builder is public, so build your blank form here rather than typing in a real patient's details. It measures interaction events only — the labels, helper text and field values you enter are never sent to analytics. DocRepute is HIPAA-focused and built for HIPAA-compliant workflows, with BAA availability planned at launch.

From a paper packet to a form that arrives before the patient does

Take the PDF today; nothing here is held back. What actually changes the front desk's morning is the same questions answered online the evening before, so the history is in your hands before the patient reaches the parking lot. DocRepute is a HIPAA-focused patient-experience platform for independent US practices, in early access ahead of launch, and it is built around exactly that: digital intake that branches, so a returning patient with a chronic nail problem is not walked through the same forty questions as a first-time runner with heel pain. The free tier includes 50 action credits a month, used only when a patient completes a regular intake submission or a standard survey — creating, editing and publishing forms uses none, and the free tier carries no AI. Paid plans add AI intake that asks practice-approved follow-ups when an answer is thin, conversational surveys, and sentiment and topic analysis. And when another practice is sending the patient to you, that handoff is a different document with a different author, and it has a preset of its own.