Intake Form Library

Intake Form Library

Intake Form Library

Healthquest has an extensive list of intake forms that are available to all clinics that utilize the feature. The list of public intake forms is below, new forms are added often, so check back regularly. 

Public Intake Forms

*Updated June 9, 2025
  1. ADHD Rating Scale IV - Preschool Version
  2. ADHD RS-IV with Adult Prompts
  3. Adolescent Autism Spectrum Quotient (AQ)
  4. Adult AHDH Self Report
  5. AHS Database 1 and 2
  6. Asthma Control Test (ACT)
  7. Back Bournemouth Questionnaire
  8. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
  9. Behavior Rating Inventory of Executive Function (BRIEF) - Adult Version
  10. Brief Michigan Hand Outcomes Questionnaire (Brief MHQ)
  11. Brief Pain Inventory
  12. Burn's Depression Checklist
  13. Canadian Chiropractic Protective Association - Consent to Chiropractic Treatment
  14. Carpal Tunnel Syndrome Questionnaire (CTSQ)
  15. Childhood Autism Spectrum Test (CAST)
  16. COPD Assessment Test (CAT)
  17. COVID-19 Assessment
  18. CPSA Practice Readiness Assessment Patient Consent
  19. DSM-IV Criterion A1/A2
  20. Eating Disorder Diagnostic Scale
  21. Electronic Consent
  22. EQ-5D-5L
  23. Fitzpatrick Skin Type Tester
  24. Food Allergy Quality of Life Questionnaire - Parent Form (FAQoL-PF) for Children 0-3
  25. Food Allergy Quality of Life Questionnaire - Parent Form (FAQoL-PF) for Children 4-6
  26. Food Allergy Quality of Life Questionnaire - Parent Form (FAQoL-PF) for Children 7-12
  27. GAD-7
  28. Generic Vaccine Consent Form
  29. Get Active Questionnaire
  30. Headache Impact Test (HIT-6)
  31. Influenza (Flu) Vaccine Consent Form
  32. LEFS
  33. Mood Disorder Questionnaire
  34. Neck Bournemouth Questionnaire
  35. Oral Immunotherapy Gastrointestinal (OIT GI) Questionnaire
  36. PaCT Care Plan
  37. Pain Catastrophizing Scale
  38. Pain Rating Scale
  39. ParQPlus2022
  40. Patient Rated Wrist Evaluation
  41. Pediatric Symptom Checklist-17 (PSC-17)
  42. Pediatric Symptom Checklist-17 (PSC-17) - child
  43. PHQ-9 modified for Adolescents (PHQ9A)
  44. QuickDASH Outcome Measure
  45. Rheum Info Health Assessment Questionnaire-II (HAQ-II)
  46. SCARED - Child Version
  47. SCARED - Adult Version
  48. STOP-Bang Questionnaire
  49. SNAP-IV 26
  50. The Burns Anxiety Inventory
  51. The Migraine Disability Assessment Test
  52. The Patient Health Questionnaire (PHQ-9)
  53. Vanderbilt AHDH - Parent
  54. Visual Analogue Scale - Hand/Wrist
  55. Wender Utah Rating Scale for ADHD
  56. WOMAC Pain Score for OA
  57. Zung Anxiety Assessment Tool

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