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Medical Intake Form

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Printable patient intake and registration form with personal, insurance, medical history, and consent sections.

Takumi Forme
Rendering PDF…

Installation

$ pnpm dlx shadcn@latest add @angular-pdfcn/forme/medical-intake-form

Usage

import { Component } from "@angular/core";

import { MedicalIntakeFormDocument } from "@/components/pdf/blocks/medical-intake-form/medical-intake-form";

@Component({
  imports: [MedicalIntakeFormDocument],
  template: `
    <pdf-medical-intake-form
      accentColor="#0d9488"
      clinicAddress="200 Health Plaza, Denver, CO 80202"
      clinicName="Sunrise Family Medicine"
      clinicPhone="(303) 555-0180"
    />
  `,
})
export class MedicalIntakeFormDemo {}

Sections

Every section is rendered by default and can be hidden by setting its input to false.

<pdf-medical-intake-form
  clinicName="Sunrise Family Medicine"
  personalInfo
  emergencyContact
  [insurance]="false"
  medicalHistory
  medications
  allergies
  reasonForVisit
  consent
/>
Input Section
personalInfo Name, date of birth, gender, phone, email, and address fields
emergencyContact Contact name, relationship, and phone fields
insurance Provider, policy, group, and subscriber fields
medicalHistory Condition checklist with allergy and medication prompts
medications Medication, dosage, frequency, and prescribing doctor table
allergies Allergen, reaction, and severity table
reasonForVisit Free-text area for symptoms and reason for the visit
consent HIPAA authorization, treatment consent, and signature lines

Inputs

Input Type Description
clinicName string Clinic name shown in the header and consent text
clinicLogo string Optional logo image source
clinicAddress string Address shown in the header and footer
clinicPhone string Phone number shown in the header and footer
accentColor string Theme token or CSS color used for section rules and accents
theme PdfcnTheme Theme override for the whole document