A telehealth intake form for clinics, urgent-care groups, and mental-health practices capturing patient intake before a virtual visit. AI flags clinical urgency and routes to the right provider in Taskade.
What's Included
- Medical History Form: Current symptoms, medication list, allergies, past conditions, family history with structured fields
- Insurance & ID Upload: Secure file upload for insurance card, government ID, and lab results
- Triage Agent: AI agent reads intake and flags clinical urgency — same-day appointment, 48-hour, routine, refer to ER
- Provider Routing: Automation routes the intake to the right specialty and the right scheduling block based on triage urgency
- Pre-Visit Summary: Provider receives a 1-paragraph summary of the patient's intake before the call starts
Why This Template Wins
- No competitor has shipped this: ClickUp, Notion, and the major form tools have zero healthcare-specific intake templates with triage AI. This is genuinely novel territory for Taskade
- Triage in 30 seconds: Most telehealth practices triage manually — receptionist reads intake, decides scheduling. The Triage Agent does this in 30 seconds with the same accuracy as a trained triage nurse on routine cases (the agent always flags edge cases for human review)
- Provider walks in informed: The pre-visit summary means the provider isn't reading the chart for the first 5 minutes of the call — they're already prepped on history, current symptoms, and the patient's stated goal
How to Use
- Clone this template into your Taskade workspace
- Customize intake fields for your specialty (mental health, urgent care, dermatology, etc.)
- Configure HIPAA-eligible plan and BAA execution before going live
- Train the Triage Agent on your specialty-specific clinical guidelines
- Set up automation triggers for provider routing and same-day-urgency alerts
FAQ
Does Taskade sign a BAA for HIPAA-covered entities?
BAA-eligible plans are available on Business ($40/mo) and above. Contact sales for execution. The workspace's audit logs and access controls satisfy most HIPAA technical safeguard requirements.
Can the Triage Agent be trained on our clinical protocols?
Yes. Train the agent on your specialty's clinical guidelines, your specific triage rubric, and any state-specific requirements. The agent's triage decisions reflect your protocols rather than generic medical reasoning.
What about state telemedicine licensure requirements?
The intake form captures the patient's state of residence at intake — combined with provider routing automation, patients only see providers licensed in their state. Out-of-state patients route to a referral pathway.
CTA
Try this template free in Taskade. For HIPAA setup, see /learn/genesis/genesis-faq. To generate a custom telehealth form, try the AI Form Generator. Browse more healthcare apps in the Community Gallery.