The intake form, filled in front of you

Watch a patient complete BrightPath Dental's digital intake form on a tablet — no paper clipboard, no handwriting for the front desk to decode.

Starting the demo…

BrightPath Dental

Patient intake form · Takes about 2 minutes

0% complete

Patient information

Full name

e.g. Jane Smith

Date of birth

MM/DD/YYYY

Mobile phone

(215) 555-0100

you@example.com

Today's visit

Reason for visit

Cleaning & exam Tooth pain Checkup Something else

Appointment

Today · 4:00 PM · Dr. Patel

Insurance

Insurance provider

Provider name

Member ID

On your card

Health history

High blood pressure Flagged for the team

Diabetes Left unchecked — No

Heart condition Left unchecked — No

Allergies

None, or list them

Current medications

Name and dose

Consent & signature

I confirm this information is correct and I agree to be contacted about my appointment.

Signature

Sign with your finger

✓ Form received — thank you, Sarah!

BrightPath Dental has everything ready for today at 4:00 PM with Dr. Patel. A confirmation text is on its way to (215) 555-0148.

Meanwhile, at the front desk

New intake received — Sarah Mitchell · Cleaning & exam · Today · 4:00 PM · Dr. Patel
Chart created automatically · Insurance (Delta Dental) queued for verification · High blood pressure flagged on the chart

Restart #0 · BrightPath Dental

What just happened

No paper, no clipboard. The patient typed everything herself on a tablet — nothing for the front desk to re-enter or misread.
The front desk got it instantly. The completed form lands on the team's screen the second she taps Submit — chart created, health flags visible.
Insurance is ready before the visit. Provider and member ID arrive with the form, so coverage can be verified ahead of time — not chased by phone later.