You can build your own consent forms and patient-fillable questionnaires in Cerbo! Or, to use our pre-built forms, check the boxes below beside the forms that you want. Then scroll down to the bottom of the page to include any additional notes, if desired, and submit your request. 

• You can edit most of the forms in this list once they are posted on your build, as desired. Any that are marked with a *** are NOT editable (generally because they have functionality, such as scoring, that is not yet supported in the Cerbo form builder).
• Some forms - such as the Medicare Private Contract and the Notice of Privacy Practices - should be edited to include key information that is specific to your practice before you post them for patients to see.

For your own - and your patients - convenience, it is highly recommended that you be selective about the forms that you post on your Patient Portal. Having too many, or highly duplicative, forms can cause confusion and frustration. 

Intake/ General Pre-Visit Forms

Preview Medical History (F)

Preview Medical History (M)

Preview Social History

Preview Family History

Preview Symptom Review (M)

Preview Symptom Review (F)

Preview Review of Systems (F)

Preview Review of Systems (M)

Preview Medical Symptom Questionnaire***

Preview Readiness Questionnaire

Preview Health Action Plan

Preview DPC Intake

Preview Health Journey

Preview Follow Up Visit - Brief Questionnaire

Pediatric and Maternity

Preview Breastfeeding - Initial Infant Visit

Preview Breastfeeding - Prenatal Consult

Preview Pediatric History (short)

Preview Pediatric History (long)

Preview Pediatric Intake

Preview Pediatric Symptom Review 1

Forms Specific to Certain Symptoms, Systems, or Exposures

Preview Adrenal Questionnaire

Preview Biotoxin Illness Survey

Preview Blood Sugar and Insulin Resistance Questionnaire

Preview Environmental Exposure Questionnaire

Preview Food and Yeast Allergy Questionnaire

Preview HPA AXIS Questionnaire***

Preview Inflammatory Bowel Disease Questionnaire (short)

Preview Mold Screening***

Preview Parasite Questionnaire***

Preview Thyroid Questionnaire

Preview Tick-Borne Disease Questionnaire

Preview Tick-Borne Illness Screen (Horowitz)***

Hormones, Reproduction, Gender, Sexuality Questionnaires

Preview ADAM Men's Hormone Questionnaire

Preview Gender Identity and Sexual Orientation Questionnaire

Preview Hormone Questionnaire

Preview International Prostate Symptom Score I-PSS***

Preview Men's Questionnaire

Preview Post-Perimenopausal Questionnaire***

Preview Women's Questionnaire

Consent Forms

Preview Authorization to Release Medical Records TEXAS

Preview Authorization to Release Medical Records

Preview General Consent to Treatment

Preview Female Hormone Replacement Therapy Informed Consent

Preview Informed Consent for Testosterone Therapy

Preview Medicare Private Contract

Preview Notice of Privacy Practices

Preview Permission to Share Medical Information with Other Individuals

Preview Telehealth Consent Form

Diet/ Nutrition

Preview 3-Day Food Diary

Preview Digestion Questionnaire

Preview Food Survey

Preview Metabolic Assessment Form***

Mental State Questionnaires

Preview ACE Score***

Preview Alzheimers Questionnaire***

Preview Depression Anxiety Stress Scales

Preview Depression Symptoms***

Preview DISC Communication Styles***

Preview Edinburgh Postnatal Depression Scale

Preview GAD-7 Questionnaire***

Preview Insomnia Questionnaire

Preview Memory Questionnaire***

Preview Mood Disorder Form

Preview NICHQ Vanderbilt Assessment Scale - PARENT

Preview PC PTSD-5

Preview PCL-5***

Preview PHQ-9 Questionnaire***

Preview Screen for Child Anxiety Related Disorders (SCARED) - Child Version

Preview Screen for Child Anxiety Related Disorders (SCARED) - Parent Version

Preview STOP-BANG Sleep Apnea Questionnaire

Preview Yale-Brown Obsessive Compulsive Scale (Y-BOCS)***

Physical Therapy/ Pain

Preview Brief Pain Inventory

Preview Disabilities of the Arm, Shoulder, and Hand Questionnaire***

Preview Dizziness Handicap Inventory***

Preview Lower Extremity Functional Scale***

Preview Lysholm Knee Scoring Scale

Preview Oswestry Low Back Pain Questionnaire***

Preview Neck Disability Index***

Preview Pain and Dysfunction Intake

Preview Pain Questionnaire (Short Form McGill)

Preview Patient Personal Injury History***

Preview Shoulder Pain and Disability Index - SPADI

Spanish-Language Forms

Preview Aviso de Practicas de Privacidad y Autorizacion

Preview Consentimiento del Paciente

Preview INITIAL HORMONE THERAPY INTAKE (MALE)

Preview INITIAL HORMONE THERAPY INTAKE (FEMALE)

Preview Checkbox Form