Technology · Intake Forms
One intake. 0+ conditions.
The clinical front door of your brand: a conversational intake with conditional logic, photo capture, and safety gates built by clinicians, with every completed flow routed to a licensed provider on a 15–60 minute SLA.
GLP-1 eligibility · question 12 of 14
Any personal or family history of medullary thyroid carcinoma or MEN2?
Try it
Run a real intake, right now
These open the live demo store in a new tab: same engine, sample data, nothing stored.
Whole-care intake
One entry point across the full catalog: pick a goal, get the right flow.
Start the flowGLP-1 weight loss
The deep flow: history, safety gates, GLP-1 eligibility, titration-ready.
Start the flowMental health
Mood and focus with the 988 crisis red-flag built into the logic.
Start the flowSame-day visit (UTI)
An acute visit: fast triage, urgent-care red-flags, same-day script.
Start the flowClinical guardrails
Smart enough to say no.
An intake that only converts is a liability. Ours qualifies (and disqualifies) with clinical rules on every answer.
Conditional logic
Every answer routes the next question: a 60-second flow for the healthy path, real clinical depth where it matters.
Clinical red-flags
Disqualifying answers stop the flow and route to in-person care: MTC/MEN2 history gates GLP-1s, nitrates gate ED treatment, crisis answers surface 988 immediately.
Photo capture
Dermatology and other visual conditions collect photos inside the flow, so the clinician reviews a complete chart on the first pass.
Routed on an SLA
A completed intake lands in a clinician queue routed by state licensure and condition, reviewed in 15–60 minutes.
The architecture
Five tiers, one chart
Every condition runs the same layered engine; that's how 160+ intakes stay clinically consistent instead of becoming 160 separate forms.
Universal intake
Identity, vitals, allergies, medications: asked once, reused everywhere.
Gender-gated branches
Flows fork only where clinically relevant, no wasted questions.
Symptom wrapper
Structured symptom capture: onset, duration, severity, context.
Condition review
A condition-specific review of systems for each of 160+ conditions.
Rules & safety
Decision rules and safety gates run across every answer before a clinician ever sees it.
160+ conditions · 14 decision rules · 39 safety gates, maintained once, inherited by every brand on the platform.
Embed anywhere
Drop your intake on any page.
Two lines of code turn any landing page, blog post, or funnel into a clinical front door. The widget opens your branded intake in a modal, wired straight to clinician review.
Prefer a full storefront? That's built too: see e-commerce.
<script src="https://embedcare.com/embed.js" async></script> <a data-embedcare="yourbrand">Start your visit</a>