What is the podiatry intake form template?
A podiatry appointment usually starts with the same questions: what's wrong, which foot, since when, and whether there's anything in the person's health — diabetes, circulation, blood thinners — that changes how the clinician will assess or treat them. This template asks all of that before the patient arrives, so the time in the chair goes on the feet rather than the paperwork.
Patients choose what brings them in from a checklist that covers heel pain, ingrown and thickened nails, corns, verrucas, bunions, sports injuries, routine care and diabetic foot checks. They say which foot, how long it's been a problem and how bad the pain is at its worst, and can upload a photo of the area. The health page asks "Do you have diabetes?" and about signs such as cold feet, cramps when walking, numbness and slow-healing cuts.
Footwear, activity level, previous insoles or orthotics and any earlier podiatry care come next, followed by a consent page with your own clinic information and a signature. Every completed intake is saved as a PDF in your FileIt vault, with the photo filed alongside it.
- Best for
- Podiatry and chiropody clinics, foot health practitioners
- Filled in by
- The new patient, before the first appointment
- Time to complete
- About 5 minutes
- Includes
- Problem checklist, pain scale, diabetes and circulation screening, footwear, signature
Who uses a podiatry intake form?
- A podiatry clinic sends the form with every new-patient booking confirmation
- A runner with heel pain describes when it's worse before a biomechanical assessment
- A patient with type 2 diabetes books an annual foot check
- A mobile foot-care practitioner collects health details before a home visit
- A patient uploads a photo of an ingrown toenail when booking
- A clinic updates returning patients' health details once a year
Questions on this podiatry intake form
34 questions over 5 pages · includes signature, file upload, conditional questions, multiple pages, consent checkbox, ratings.
1 Your details
- Your name*
- Date of birth*
- Mobile*
- Email*
- Home address
- Your doctor or GP practice
- How were you referred? Self-referral · My doctor · Diabetes clinic · Physiotherapist · Another podiatrist · Other
2 Your feet
- What brings you in?* Heel pain · Ball-of-foot pain · Ankle pain · Ingrown toenail · Thickened or discoloured nails · Corns or hard skin · Verruca or warts · Bunions or toe shape · Flat feet or high arches · Sports injury · Routine foot care · Diabetic foot check
- Which foot?* Left · Right · Both
- How long has it been a problem?* Less than 2 weeks · 2–6 weeks · 6 weeks to 6 months · More than 6 months · Not applicable — routine care
- Pain at its worst
- When is it worse? First steps in the morning · After resting · Walking · Standing for long periods · Running or sport · In certain shoes · At night
- Did it start after an injury?
- What happened?* asked only when it applies
- Photo of the area
3 Health screening
- Do you have diabetes?* No · Type 1 · Type 2 · Pre-diabetes · Not sure
- How is it managed, and your most recent HbA1c if you know it? asked only when it applies
- Do you have any of these?* Cold feet or colour changes · Leg cramps when walking · Swollen ankles · Numbness or pins and needles · Slow-healing cuts or ulcers · Varicose veins · None of these
- Other conditions Arthritis · Gout · Heart condition · Stroke · Kidney disease · Peripheral arterial disease · Psoriasis or eczema · Pacemaker
- Do you take blood thinners?*
- Other medication
- Allergies
- Do you smoke? Never · Used to · Yes
4 Footwear & previous care
- Shoes you wear most days Trainers · Work or safety boots · Flat shoes · Heels · Sandals or flip-flops · Slippers
- How active are you? Mostly sitting · On my feet at work · Walk regularly · Run or play sport
- Have you used insoles or orthotics before?*
- What type, and did they help? asked only when it applies
- Have you seen a podiatrist or chiropodist before?
- Where, and what treatment did you have? asked only when it applies
- What would you like to get out of your visit?
5 Consent
- Assessment and treatment*
- My information*
- Reminders
- Signature*
The podiatry intake form, page by page
1 Your details
Required name, date of birth, mobile and email, an optional home address, the patient's doctor or GP practice, and "How were you referred?" — self-referral, doctor, diabetes clinic, physiotherapist or another podiatrist.
2 Your feet
The required checklist "What brings you in?" with twelve common reasons and an Other option, then "Which foot?" and "How long has it been a problem?". A 0–10 "Pain at its worst" scale and "When is it worse?" follow. Answering yes to "Did it start after an injury?" asks what happened, and an optional photo upload takes up to two images.
3 Health screening
"Do you have diabetes?" is required; any answer other than no asks how it's managed and the most recent HbA1c if known. A required checklist covers cold feet, cramps when walking, swollen ankles, numbness, slow-healing cuts and varicose veins. Then other conditions, the required "Do you take blood thinners?", other medication, allergies and smoking.
4 Footwear & previous care
Shoes worn most days, activity level, the required "Have you used insoles or orthotics before?" (a yes asks what type and whether they helped), previous podiatry care and "What would you like to get out of your visit?".
5 Consent
A placeholder paragraph for your clinic information, required consents to assessment and treatment and to the accuracy of the health information, optional appointment reminders, and the patient's signature.
Make the template yours
- Replace the placeholder paragraph with your fees, cancellation policy and how you keep records
- Trim the problem checklist to the services you actually offer
- Add a gait or running-shoe question for a sports podiatry clinic
- Add a page for a carer's details if you visit housebound patients
- Set the vault folder per clinician so each sees their own new patients
- Change the document title to include the appointment date
Tips for a better podiatry intake form
- Ask patients to bring the shoes they wear most — the form tells you which ones they are
- Read the circulation and blood-thinner answers before nail surgery bookings
- Use an emailed request so you know which new patients haven't filled it in yet
- Encourage a photo for nail and skin problems — it helps triage the booking length
- Re-send the form to long-standing patients each year to keep health details current
Every response becomes a PDF in your vault
Each intake is saved as a signed PDF in your vault, with any photos filed as attachments. You're notified by email, and the patient can be sent a copy for their own records.
In the Responses table you can search for a patient by name, open the full answers before the appointment and export the list to CSV.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Podiatry intake form: frequently asked questions
Is this podiatry intake form free?
Yes. It's one of the starter templates in the FileIt Forms app, available on every account, and you can change any question.
Can patients upload a photo of their foot?
Yes. The "Your feet" page has an optional upload for up to two photos, filed as attachments of the patient's PDF.
Why does it ask about diabetes and blood thinners?
These are questions podiatrists commonly ask before an assessment. Edit or remove them to match your own clinical process.
Can I add my own terms?
Yes. Replace the placeholder paragraph on the consent page with your own clinic information and policies.
Does the patient sign the form?
Yes. The last page ends with a signature the patient draws or types on their phone or computer.
Do patients need a FileIt account?
No. They fill it in from a link or an emailed request.