A symptom-focused clinical intake form that zooms in on the chief complaint using an OLDCARTS-style block — onset, duration, character, aggravating and relieving factors, radiation, treatment tried, severity, and red flags.
Quick answer
A symptom-focused intake form captures the chief complaint in a structured OLDCARTS block (onset, duration, character, aggravating/relieving, radiation, treatment tried, severity) plus red-flag prompts.
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.
General intake buries the presenting problem. This form starts with the symptom itself and pulls it apart: when did it start, how does it feel, what makes it worse, does it travel anywhere, what have you tried, how bad is it today — plus a red-flag block that forces escalation when chest pain, breathing difficulty or sudden weakness appear.
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.
Structured detail on arrival — no more “just a headache” ambiguity.
Every consultation starts with the symptom sheet already in the chart.
Radiation, aggravating movement, prior treatment all captured before the appointment.
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.
