Oncology Intake Form
Form Preview
Oncology Intake Form
Page 1 of 4
Sign up and start customizing in minutes.
The Oncology Intake Form is purpose-built for cancer care practices, capturing the detailed oncologic history that oncologists need for treatment planning and continuity of care. This template collects patient demographics alongside a comprehensive cancer history covering primary diagnosis (site, histology, stage, grade, molecular markers), date of diagnosis, prior treatments received (surgery, chemotherapy, radiation, immunotherapy, targeted therapy, hormonal therapy), treatment responses, and current disease status. The symptom assessment section screens for cancer-related symptoms including pain, fatigue, nausea, appetite changes, weight loss, neuropathy, and cognitive changes.
Designed for medical oncology, radiation oncology, surgical oncology, and comprehensive cancer centers, this form includes sections for prior pathology and imaging results, current and completed clinical trial participation, genetic testing and counseling history (BRCA, Lynch syndrome, hereditary cancer panels), and a thorough oncologic medication list covering chemotherapy agents, targeted therapies, immunotherapy, supportive medications (antiemetics, growth factors, pain management), and supplements. The psychosocial screening section captures distress level, caregiver information, advance directive status, and supportive care needs.
All fields are HIPAA-compliant and optimized for the oncology workflow. The multi-page format allows patients to document their cancer journey comprehensively before the consultation, including treatments received at other facilities. This pre-visit data collection is especially valuable in oncology where patients often have complex, multi-modality treatment histories that span multiple providers and institutions.
What's included
- Cancer diagnosis with staging and molecular markers
- Treatment history across surgery, chemo, and radiation
- Symptom burden and pain assessment documentation
- Genetic testing and hereditary cancer screening
- Psychosocial distress and supportive care needs
- Consent agreement with advance directive documentation
Who uses this template
- Medical oncology and hematology-oncology practices
- Radiation oncology and treatment planning centers
- Comprehensive cancer centers and tumor boards
- Cancer survivorship and follow-up care programs
All form fields
16 fields across 4 pages. Customize any field after signing up.
How to use the Oncology Intake Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Oncology Intake Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Oncology Intake Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 16 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Oncology Intake Form HIPAA compliant?
Yes. All Formisoft templates, including the Oncology Intake Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 16 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Oncology Intake Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Oncology Intake Form for your practice. Set up in minutes.
Related templates
Acupuncture Intake Form
Acupuncture-specific intake covering chief complaint, TCM constitution assessment, pain mapping, lifestyle and emotional health, and treatment history. For licensed acupuncturists and integrative medicine clinics.
Addiction Medicine Intake Form
Addiction medicine intake covering substance use history, withdrawal risk assessment, medication-assisted treatment screening, mental health comorbidities, recovery support systems, and treatment readiness. For addiction medicine practices and MAT programs.
Allergy & Immunology Intake Form
Allergy and immunology intake with detailed allergy history, environmental triggers, reaction severity, immunodeficiency screening, and medication/immunotherapy history. For allergists and immunologists.