Forms and NTSF
PATIENT INTAKE FORMS
Patient intake forms for clinical research are specialized questionnaires used to screen trial candidates, verify eligibility criteria, and securely collect baseline medical data.
These forms are critical to the integrity of a study, ensuring researchers gather structured data while fully accounting for factors that might impact trial outcomes.
Core Components of a Clinical Research Intake Form
A robust intake process requires several specific categories of information to meet regulatory and clinical standards:
Participant Demographics: Name, date of birth, contact details, emergency contacts, legal sex, and gender identity.
Screening Criteria: Study-specific questions verifying inclusion and exclusion parameters to determine candidate eligibility.
Medical History: Current symptoms, past surgeries, hereditary conditions, and an exhaustive list of current medications and dosages.
Allergies: Known adverse reactions to medications, food, or environmental triggers.
Consent & Legal Authorization: HIPAA authorization, release of records, and informed consent disclosures that meet strict privacy requirements.
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