A chronic care follow-up intake form for long-term conditions — capture current readings (BP, glucose, weight), medication adherence, lifestyle changes, exacerbations since last visit, and the next-step plan.
Quick answer
A chronic care follow-up intake form captures current readings, medication adherence, lifestyle, exacerbations and next-step plan for patients living with long-term conditions — the same structure every review.
Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified clinician before making care decisions.
Chronic care works when the same set of questions is asked at every review. This form covers the shared spine (readings, medications, adherence, lifestyle, exacerbations, plan) plus condition-specific branches for diabetes, hypertension, asthma, COPD, CKD and heart failure. Between visits patients submit it; at the appointment the clinician sees one consistent structure they can compare across time.
Try the actual running form — not a screenshot — before you copy it.
Everything you need to run this template.
From copy to deliverable in four steps.
Copy the form and its branding settings into your FormLM workspace — free; you can upgrade to a scored assessment with an AI PDF report any time.
Adjust fields, options and consent language to match your clinic workflow.
Send the link or QR; every response is captured automatically.
Export or review the collected responses at any time from one dashboard.
Pick your role — see how it fits your clinic workflow.
Every three-month review uses the same fields; trends appear automatically.
Peak-flow and inhaler technique captured before the appointment.
Daily weights, swelling, dyspnea and lab values logged in a consistent format.
What makes this template work as a professional clinical deliverable.
A preview of real fields patients see — the full version is a live form — responses are captured automatically and can be exported at any time.
