1

Online Intake Form

active

Demographics, emergency contact, insurance information, presenting concerns, and consent forms.

DemographicsEmergency ContactInsurancePresenting ConcernsConsent & Privacy
2

Insurance Verification

active

Upload insurance card, AI extracts member ID and payer, verify eligibility and benefits in real-time.

Card UploadAI ExtractionEligibility CheckBenefits Summary
3

Clinical Screening

active

PHQ-9 depression screen, GAD-7 anxiety screen, initial risk assessment, and diagnostic impressions.

PHQ-9GAD-7Risk ScreenDiagnostic Impressions
4

Provider Assignment

active

Match patient to provider based on specialty, caseload availability, insurance acceptance, and schedule.

Specialty MatchCaseload CheckInsurance PanelSchedule First Appointment

Insurance Card AI Extraction

Upload a photo of the insurance card. AI extracts payer, member ID, group number, and plan type.

Drop insurance card image here

JPG, PNG, or PDF

Recent Patient Intakes

Patient Insurance Intake Form Screening Provider Status
Sarah Mitchell BlueCross BlueShield of TN Complete Complete Assigned Active
James Okafor Cigna Complete Complete Assigned Active
Maria Gonzalez Aetna Complete Complete Assigned Active
Robert Chen UnitedHealthcare Complete Pending Assigned In Progress
Destiny Brooks BlueCross BlueShield of TN Complete Pending Pending In Progress